Diverse diets for stronger bones: Study reveals how alternative eating habits prevent osteoporosis

By Priyanjana Pramanik, MSc.Oct 8 2023Reviewed by Benedette Cuffari, M.Sc.

A recent study published in the journal Nutrients explores the role of different dietary patterns in protecting older people from osteoporosis and related fractures.

Study: Association of Alternative Dietary Patterns with Osteoporosis and Fracture Risk in Older People: A Scoping Review. Image Credit: Art_Photo / Shutterstock.com

What is osteoporosis?

Aging impacts bone health and hormone levels, which could reduce bone mineral density (BMD). Osteoporosis, a bone disease associated with lowered BMD and bone mass, increases the risk of fractures.

Osteoporosis is a significant cause of illness and death among older people and appears to affect more women than men. Current estimates indicate that over 200 million people have osteoporosis, which has become one of the most common non-communicable diseases in the world. Osteoporosis can be treated effectively, even prevented, but is often not detected before a fall or fracture.

Identifying factors that prevent bone density loss and fractures can help create guidelines to reduce osteoporosis risk. For example, modifying diets could reduce the burden of the disease.

Nutritionists have established that consuming more fruits, vegetables, and seafood can be beneficial. Mediterranean diets (MD) and diets including foods with lower Dietary Inflammatory Index (DII) scores also have a protective effect; however, the potential benefits of other dietary patterns have not been studied thoroughly.

About the study

Although most previous studies used traditional MD scores to determine the impact of MD on osteoporotic fracture risk in Mediterranean populations, traditional MD ingredients are not always available in other regions of the world. As a result, the authors of the present study examined the modified MD (mMED) and alternative MD (aMED), as well as other traditional dietary patterns such as Nordic or Chinese diets.

Various scoring systems of dietary quality are currently available, such as the Alternative Health Eating Index (AHEI), Healthy Eating Index (HEI), Baltic Sea Diet (BSD), and Dietary Approaches to Stop Hypertension (DASH), each of which was evaluated in this study. These dietary scoring systems treat different components such as meat products, dairy, fats, and sodium differently.

A comprehensive literature review was performed using Embase, Medline, and Scopus databases to identify scientific articles published between 2000 and 2022. All papers were based on original research that studied the relationship between different diets and osteoporosis and its symptoms.

Each of the selected studies for the review was observational and used a cross-sectional or prospective cohort design. Study participants were over 50 years of age and could be of any ethnicity or race.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) were applied for the current review. The initial search yielded 507 results, which ultimately led to the identification of six relevant papers for the analysis.

From these articles, information related to participant characteristics, sample sizes, diet scores, dietary findings, and results were obtained. This information was examined through a descriptive synthesis and a multivariable-adjusted analysis.

Study findings

Two of the six studies were cross-sectional, whereas the others were prospective cohort studies, all published after 2015. The study populations were European, American, and Asian and between the ages of 50 to 85 years.

The sample sizes varied widely, with the smallest comprising less than 1,000 individuals and the highest greater than 10,000. Two studies examined BMD as an outcome, while others examined hip and other osteoporotic fractures. Medical data was either self-reported or obtained from patient registers.

Two of the studies examined the association between diet score and osteoporosis or BMD. To this end, no relationship between bone density and BSD scores or DASH scores was reported.

However, stricter adherence to the DASH guidelines reduced the probability of developing lumbar spine osteoporosis. The DASH diet was associated with a lower lumbar and femoral neck BMD than the BSD.

Four studies investigated the link between diet scores and osteoporotic fractures. Moreover, following the mMED or aMED diets reduced the risk of hip fractures in both Swedish and American cohorts. Although other diets did not show the same relationship, better adherence was more protective than lower adherence.

Conclusions

The study findings provide important insights into how healthy diets, besides the well-known Mediterranean diet, can prevent bone density loss and osteoporotic fractures. Nevertheless, further studies are needed to create holistic health guidelines.

Likewise, future observational studies should follow study participants from many races, ethnicities, and geographies over more extended periods of time. Future studies should also aim to be consistent regarding sample sizes and age limits so that findings can be compared. Regional diets should also be included.

A healthy diet alone is insufficient for preventing osteoporosis, as several studies have emphasized the important role of exercise in preventing osteoporosis. Thus, combining diet and exercise could decrease the risk of fractures and improve osteoporosis outcomes.