Association of Mediterranean Diet Adherence with Self-Reported Muscle-Related Functional Status and Fracture...

Background: Osteoporosis and sarcopenia frequently coexist in older adults and jointly contribute to increased risk of falls and fragility fractures. While adherence to the Mediterranean diet (MD) has been broadly associated with favorable health outcomes, its potential role in modulating muscle-related functional status and, indirectly, fracture risk remains incompletely understood. Objective: To investigate the association between adherence to MD and SARC-F-assessed functional status, and to explore their interplay with FRAX-estimated fracture probability in postmenopausal women evaluated for osteoporosis. Methods: Adherence to the MD was assessed using the Medi-Lite questionnaire. Muscle-related functional status was evaluated through the SARC-F questionnaire and objectively measured by handgrip strength. Fracture probability was estimated using the FRAX tool. Correlation and multivariable analyses were performed to evaluate associations among study variables. In addition, an exploratory indirect-effect analysis was conducted to investigate whether functional status might represent a potential intermediate pathway linking MD adherence and FRAX-estimated fracture probability. Results: A total of 96 participants (median age 66 years) were consecutively recruited. Greater adherence to the MD was associated with lower SARC-F scores (r = -0.292; p = 0.005), indicating better muscle-related functional status. SARC-F scores were inversely correlated with handgrip strength (r = -0.264; p = 0.013) and positively correlated with the estimated 10-year probability of major osteoporotic fractures (r = 0.289; p = 0.005) and hip fractures (r = 0.277; p = 0.008). No significant associations were observed between MD adherence and FRAX-estimated fracture probability, bone mineral density, or prevalent fractures. In the exploratory indirect-effect analysis, a significant indirect association between MD adherence and FRAX-estimated fracture probability through SARC-F score was observed, whereas the direct association was not significant. Conclusions: In postmenopausal women referred for osteoporosis evaluation, greater adherence to the MD was associated with better self-reported muscle-related functional status but not directly with FRAX-estimated fracture probability. These findings are consistent with the hypothesis that functional status may represent an intermediate link between dietary habits and estimated fracture risk. However, because dietary adherence, functional status, and fracture risk were assessed simultaneously, no causal or temporal inferences can be drawn. Consequently, the indirect-effect findings should be regarded as exploratory and hypothesis-generating, requiring confirmation in adequately powered longitudinal and mechanistic studies.