Mediterranean diet and skeletal health: Mechanistic pathways and implications for osteoporosis

The Mediterranean diet has emerged as a promising dietary pattern with potential benefits for skeletal health, particularly in the prevention of osteoporosis. This narrative review aims to synthesize current evidence on the relationship between adherence to the Mediterranean diet and osteoporosis risk, focusing on both biological mechanisms and epidemiological findings. Rich in fruits, vegetables, whole grains, legumes, nuts, and olive oil, alongside moderate fish intake and low consumption of red meat, the Mediterranean diet provides a rich source of bioactive compounds, including polyphenols, omega-3 fatty acids, vitamins, and minerals essential for bone metabolism. These components exert synergistic effects by reducing oxidative stress and chronic inflammation, key contributors to bone loss, while also modulating gut microbiota and enhancing nutrient bioavailability. Evidence from observational studies consistently suggests an inverse association between adherence to the Mediterranean diet and fracture risk, although findings on bone mineral density remain heterogeneous. Intervention studies, while limited, generally support a beneficial role of this dietary pattern in improving bone health markers. Despite these promising findings, methodological variability and limited long-term randomized controlled trials warrant cautious interpretation. Overall, the Mediterranean diet represents a promising and feasible non-pharmacological approach for osteoporosis prevention, although further research is needed to clarify its long-term impact and underlying mechanisms.