BHOD: a bone health optimized dietary pattern designed for osteoporosis prevention

Existing dietary patterns were not specifically designed to target osteoporosis and lack the precision required for effective prevention. We aimed to develop a Bone Health Optimized Diet (BHOD) that is tailored to more precisely reduce the risk of osteoporosis. Using dietary data from 183,092 UK Biobank (UKB) participants, we combined food-wide association analysis with machine learning to develop the BHOD. We identified 10 important osteoporosis-related food groups and integrated them to construct the BHOD. The protective association was observed between BHOD and the risk of osteoporosis, which was validated in both the UKB validation set and the NHANES population. Furthermore, the BHOD showed broad protective associations with other musculoskeletal disorders, such as rheumatoid arthritis and osteoarthritis. Importantly, high adherence to the BHOD mitigated the negative impact of genetic susceptibility on osteoporosis, with particularly pronounced benefits observed among individuals at high genetic risk. The multi-omics analysis identified multiple biomarkers (7 proteins, 66 metabolites, and 5 inflammatory markers) jointly associated with BHOD and osteoporosis risk, highlighting immune-inflammatory regulation and lipid metabolism as key biological pathways linking diet to bone loss.