April 05, 2016
JAMA Internal Medicine
TAKE-HOME MESSAGE
- Participants in the Women’s Health Initiative observational study completed a food frequency questionnaire, and adherence to a Mediterranean diet was assessed to evaluate the effect on fractures in postmenopausal women. Higher adherence to a Mediterranean diet was associated with a lower risk of hip fracture, but not total fractures. There was no significant association observed between fracture risk and healthy eating scores.
- Dietary factors play a role in maintaining bone health in postmenopausal women, with adherence to a Mediterranean diet showing a beneficial effect.
Primary Care
Written by David Rakel MD, FAAFP
Although the impact was small, multiple cohorts of older women who adhered to some degree of the Mediterranean diet were found to have had a lower risk of hip fracture.
Think of the skeleton as the largest buffer of acidity in the human body. If we eat foods that are acidic (for example, processed food or soda high in phosphoric acid), the body will mobilize calcium from the bone, similar to how taking a Tums helps calm down acid in the stomach.
Eating a diet rich in vegetables, high-fiber grains, fruit, nuts, olive oil, and low in red meat is a low-acidic diet that reduces the need for the body to steal calcium from bone to act as a buffer.
Throw some weight-bearing exercise in there with movement that improves balance (such as Tai Chi) and you have a darn good medicine for bone health that can reduce the risk for broken hips.
Abstract
IMPORTANCE
Considerable efforts have been undertaken to relate single nutrients to bone health. To this point, results are inconsistent. Suboptimal single nutrient intake does not occur in isolation but rather reflects a poor diet quality.
OBJECTIVE
To assess the association between adherence to a diet quality index constructed on the basis of dietary recommendations or existing healthy dietary patterns and fractures in postmenopausal women.
DESIGN, SETTING, AND PARTICIPANTS
Post hoc analysis was conducted of longitudinal data from 40 clinical centers throughout the United States included in the Women’s Health Initiative (WHI) observational study. Participants in the prospective cohort included 93 676 women who were eligible for the WHI if they were aged 50 to 79 years. Recruitment was conducted from October 1, 1993, to December 31, 1998, with the study ending August 29, 2014. The WHI food frequency questionnaire was used to derive nutrient and food intake at baseline. Diet quality and adherence were assessed by scores on the alternate Mediterranean Diet (aMED), a 9-category measure of adherence to a Mediterranean dietary pattern; the Healthy Eating Index 2010 (HEI-2010), a 100-point measure of 12 food components; the 11-item Alternate Healthy Eating Index 2010 (AHEI-2010); or the 8-component Dietary Approaches to Stop Hypertension (DASH) diet score.
MAIN OUTCOMES AND MEASURES
Outcome measures included incident total and hip fractures. Hazard ratios (HRs) by quintiles of dietary index scores were estimated using Cox proportional hazards regression analyses.
RESULTS
Of the 93 676 participants, 90 014 were included in the analysis (mean [SD] age, 63.6 [7.4]) years. During a median follow-up time of 15.9 years, there were 2121 cases of hip fractures and 28 718 cases of total fractures. Women scoring in the highest quintile (Q5) of the aMED index had a lower risk for hip fractures (HR, 0.80; 95% CI, 0.66-0.97), with an absolute risk reduction of 0.29% and a number needed to treat of 342 (95% CI, 249-502). No association between the aMED score and total fractures was observed (Q5 HR, 1.01; 95% CI, 0.95-1.07). Higher HEI-2010 or DASH scores tended to be inversely related to hip fracture risk, but the results were nonsignificant (Q5 HR, 0.87; 95% CI, 0.75-1.02; and Q5 HR, 0.89; 95% CI, 0.75-1.06, respectively). The AHEI-2010 score was associated with neither hip nor total fractures.
CONCLUSIONS AND RELEVANCE
Higher adherence to a Mediterranean diet is associated with a lower risk for hip fractures. These results support that a healthy dietary pattern may play a role in maintaining bone health in postmenopausal women.