1. Based on a post-hoc analysis of the Women’s Health Initiative, post-menopausal women’s self-reported adherence to a Mediterranean diet was associated with lower risk of hip fractures, albeit with a small absolute risk reduction.
2. Although this was a post-hoc analysis, which decreases the reliability of the results, this does lend credence to the idea that diet, rather than individual nutrients, may be necessary to improve bone health.
Evidence Rating Level: 2 (Good)
Study Rundown: Osteoporotic fractures and bone health, especially amongst post-menopausal women, remain a major public health issue. Many studies have examined the importance of single nutrients in relation to bone health, but overall poor-quality diets may be major culprits. This study, which performed a post-hoc analysis from the Women’s Health Initiative, sought to examine whether diet types were associated with risk of fracture in postmenopausal women.
Following multi-variable analysis to control for known osteoporosis risk factors, a high score on a Mediterranean diet adherence questionnaire (aMED) was associated with lower risk of hip fracture, albeit with a small absolute risk reduction. Other measures of healthy diet, including the DASH diet, were not associated with decreased risk of hip fractures. The strength of the study was the high-quality nature of the cohort and the long-term follow up. However, significant weaknesses of the study included using a post-hoc analysis and relying on self-reported dietary data.
Relevant Reading: Mediterranean diet and incidence of hip fractures in a European cohort
In-Depth [retrospective cohort]: This study examined the cohort of 93,676 post-menopausal women from the Women’s Health Initiative recruited from 1993 to 1998 and followed for a median time of 15.9 years. Hip fracture diagnoses were confirmed with medical records, while other fractures and comorbidities were self-reported by participants. To determine information on diet, participants were scored using the following questionnaires: alternate Mediterranean diet (aMED), Healthy Eating Index 2010 (HEI-2010), Alternative Healthy Eating Index- 2010 (aHEI-2010), and Dietary Approaches to Stop Hypertension (DASH). Participants reporting extremes of daily caloric intake were excluded.
Participants with scores in the top quintile of aMED score had lower risk of hip fracture (HR 0.80; 95%CI 0.66-0.97) with absolute risk reduction of 0.29% or NNT of 342. Highest quintile aMED score had no link to total fracture risk (HR 1.01; 95%CI 0.95-1.07). No other dietary score was associated with risk of hip or total fractures.
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