Association of dietary patterns with osteoporosis risk: a meta-analysis of observational studies
Bing Tan1, HongWei Su2, LanYa Wei3
1Department of Geriatric Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Qingxiu District, No. 6, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region, 530000, China.
Background:
Dietary patterns play a crucial role in osteoporosis prevention and management. Patients with osteoporosis need to select a dietary pattern for prevention. This meta-analysis aims to examine the influence of eight distinct dietary patterns on the risk of osteoporosis, including dietary inflammatory index (DII), Western/unhealthful dietary pattern, dietary approaches to stop hypertension (DASH), prudent/healthful dietary pattern, aquatic dietary pattern, plant-based diet index (PDI), healthful PDI, and unhealthful PDI.
Methods:
Embase, Web of Science, PubMed, and Cochrane Library were systematically searched for observational studies up to April 10, 2025. Meta-analysis was conducted using random-effect models. Heterogeneity was evaluated by subgroup analyses and publication bias was assessed by Egger's test. If there was a risk of bias, the sensitivity analysis and trim-and-fill analysis were conducted. The odds ratios (ORs) and 95% confidence intervals (CIs) were combined to compare the lowest and highest dietary pattern categories.
Results:
A total of 2,620 studies were retrieved, among which 2,600 were excluded. 20 observational studies, involving 8 dietary patterns were included, with 426,292 participants. The highest DII (OR: 1.82; 95% CI: 1.39, 2.37; P < 0.001) and the high adherence of unhealthful PDI (OR: 1.37; 95% CI: 1.11, 1.68; P = 0.003) were correlated with an increased risk of osteoporosis. Conversely, the highest category of the prudent/healthful dietary pattern (OR: 0.66; 95% CI: 0.53, 0.83; P < 0.001) presented a low osteoporosis risk. The Western/unhealthful dietary pattern, DASH, aquatic dietary pattern, and high adherence to PDI and healthy PDI dietary patterns were not associated with osteoporosis risk (All P > 0.05).
Conclusion:
High DII or unhealthy PDI scores were associated with an increased risk of osteoporosis, while high adherence to prudent/healthy dietary patterns reduced the risk of osteoporosis.
Trial Registration:
This paper was registered with PROSPERO (CRD42024585588).
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