Dietary Patterns and Fractures Risk in the Elderly

Abstract

PurposeAlthough the role of dietary factors in the prevention of bone loss and fractures has been investigated in many studies, few studies have examined the association between dietary patterns and total body bone density. Our aim was to determine the relations between dietary patterns and whole-body bone mineral density (WB-BMD) and the association between dietary patterns, fractures, and multiple fractures in the elderly.MethodsThis cross-sectional study included 177 individuals aged ≥65 years. A dual X-ray absorptiometry scan was performed to measure BMD. Dietary patterns were ascertained by a combination of dietary intake assessment and principal components analysis.ResultsOnly three dietary patterns correlated with whole-body bone density. The multivariate-adjusted mean bone density across tertiles of these dietary patterns showed that the highest tertile of both the patterns 1 and 2 had a significantly higher bone density than the lowest tertile (pattern 1: 1.021 ± 0.01 and 1.070 ± 0.01 g/cm2 for T1 and T3, respectively; p = 0.043; pattern 2: 1.023 ± 0.01, and 1.081 ± 0.01 g/cm2 for T1 and T3, respectively; p = 0.003). We also find significant gender difference in these results. The highest adherence to the dietary pattern 5 was associated with decreased odds of having fractures (OR = 0.20, p = 0.009), and adherence to the pattern 1 was negatively associated with multiple fractures.ConclusionA high adherence to the dietary pattern 1 (high intake of grains, fish and olive oil) was associated with a high BMD and a low number of fractures. The highest adherence to the dietary pattern 5 (legumes and wine) was associated with decreased odds of having fractures. Our finding would suggest a potential bone-preserving properties of specific dietary patterns in the elderly.

Dietary Patterns in Relation to Low Bone Mineral Density and Fracture Risk: A Systematic Review and Meta-Analysis

“…Because the labeling of the patterns is arbitrary and the dietary patterns are population specific, we considered only those patterns sharing most foods with similar factor loadings. For inclusion in the meta-analysis, the 3 most common dietary patterns having a similar factor loading of principal components were identified in 8 studies (out of 10) considering as outcome the fracture risk (22)(23)(24)(25)(26)(27)(28)(29)(30)(31) and in 10 studies considering the low BMD risk (32)(33)(34)(35)(36)(37)(38)(39)(40)(41). The first pattern, named the "Healthy" dietary pattern, was characterized by a high loading of vegetables and fruits, poultry, fish, and whole grains.…”

“…Subsequently, 62 articles were excluded because they did not meet the inclusion criteria as follows: 30 studies on dietary patterns determined by a priori methods, 29 studies not reporting the risk estimation, and 3 studies on adherence to nutrient dietary patterns. Therefore, at the end of the selection process, 20 studies were included for the identification of the different dietary patterns in the systematic review and meta-analysis (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). Ten studies considered the fracture risk (22)(23)(24)(25)(26)(27)(28)(29)(30)(31) and 10 studies the risk of low BMD (Figure 1) (32)(33)(34)(35)(36)(37)(38)(39)(40)(41).…”

“…The general characteristics of the 10 studies evaluating the association between adherence to different dietary patterns with fracture risk are shown in Supplemental Table 1. Three studies were conducted in China (23,27,28), 2 in the United States (26,31), and 1 each in Italy (22), Sweden (24), the Netherlands (25), Canada (29), and Japan (30). One was a cross-sectional study (22), 8 were cohort studies (23)(24)(25)(26)(27)(29)(30)(31), and 1 was a case-control study (28).…”

“…These studies were published between 2010 and 2017. Four studies were conducted in women and men together (20,654 individuals) (22,23,25,30), 4 studies were on women and men separately (113,753 women and 65,161 men) (26)(27)(28)(29), and 2 studies were on women only (56,861) (24,31). One study was conducted in young women (aged 18-26 y) (31) and reported data on all stress fractures, 1 study was on an adult population (≥18 y) (23), and the others were on older subjects (>30 y).…”

“…One study was conducted in young women (aged 18-26 y) (31) and reported data on all stress fractures, 1 study was on an adult population (≥18 y) (23), and the others were on older subjects (>30 y). Five studies considered hip fracture (10,012 cases) (24-28), 4 studies evaluated the number of fractures at any site (2733 cases) (22,23,25,30), and 1 study considered all low-trauma clinical fractures excluding skull, face, hands, and feet (29). The fractures were assessed by radiographic imaging (22,28,31), questionnaire (23,25,26,29), and linkage with a registry/database (24,27,30).…”