Interplay between Osteoporosis and the Mediterranean Diet: History
View Latest Version
Please note this is an old version of this entry, which may differ significantly from the current revision.
Contributor:
María Carmen Andreo-López
,
Victoria Contreras-Bolívar
,
Beatriz García-Fontana
,
Cristina García-Fontana
,
Manuel Muñoz-Torres

Diet is a modifiable factor in bone and muscle health. The Mediterranean diet (MedDiet) is rich in nutrients and contains key bioactive components with probable protective effects on muscle and bone deterioration. Osteoporosis (OP) is disease that increase frailty and susceptibility to fracture, morbidity and mortality. Therefore, it is necessary to combat them in the population. In this regard, MedDiet adherence has proven to be beneficial to bone mineral density (BMD), muscle mass, physical function, OP and sarcopenia. Hence, this diet is proposed as a therapeutic tool that could slow the onset of osteoporosis.

  • osteoporosis
  • muscle
  • MedDiet
  • women

1. Introduction

The lower risk of chronic noncommunicable diseases associated with the MedDiet is known. However, the study of the relationship between the MedDiet and bone health, more specifically bone mineral density (BMD), is recent [1]. So, current studies point to the potential benefits of the MedDiet for bone health (namely, bone mineral status, bone biomarkers and fracture incidence) [1][2][3]. In fact, several authors indicated that the low incidence of OP in Mediterranean countries could be explained by diet [2]. This diet, high in essential nutrients and other bioactive components (calcium and vitamin D, protein and magnesium (Mg), among others), is involved in maintaining healthy bones. Thus, an optimal and continuous nutrient supply is necessary to compensate for the constant remodeling of the skeleton and muscle wasting due to inflammation and oxidative stress [4]. In this regard, the anti-inflammatory properties of some of its components, such as fruits, vegetables, nuts, cereals, legumes, fish and, in particular, EVOO (as a main source of fat) seem to play a relevant role, decreasing the bone reabsorption process [5][6][7][8]. Contrarily, the Western or pro-inflammatory dietary pattern, rich in soft drinks, fried foods, meat, processed products, sweets and refined grains, is associated with OP and calcium nephrolitiasis [7][9].
However, the available data correlating the MedDiet with good bone health have been deemed controversial by a few studies. In fact, the association between the MedDiet and a lowered risk of fracture has been called into question [10][11][12].

2. Bone Mineral Status and Bone Biomarkers

The BMD was the common bone outcome measured in the majority of studies [1][3][13][14]. In fact, several of them related adherence to the MedDiet to higher BMD as well as a reduced risk of fracture [1][14]. These works have been conducted in a postmenopausal and/or elderly population [2][15][16]. However, Pérez-Rey et al. analyzed a population of Spanish premenopausal women and detected a positive association between the degree of adherence to the MedDiet and bone density assessed by DXA, QUS and pQCT [3]. Likewise, in a Chinese middle-aged and elderly population, it was found that greater adherence to the MedDiet was related to higher BMD by DXA [15]. This association was also observed in an American population [2]. Nevertheless, Kotogianni et al. observed no significant effect of the Mediterranean dietary pattern on bone mass. However, a positive relationship was found between MedDiet adherence and bone mass [17]. Similarly, in the NU-AGE (New Dietary Strategies Addressing the Specific Needs of the Elderly Population for Healthy Aging in Europe) multicenter randomized trial, participants aged 66–74 years who ingested a Mediterranean-like dietary pattern and a vitamin D3 supplement (400 IU/d) did not exhibit any effect on the BMD, but individuals with OP had a significantly reduced rate of bone loss of at the femoral neck [13].
The role of certain nutrients present in the MedDiet may have potential benefits for BMD (Table 1). Traditionally, studies have focused on the roles of calcium, vitamin D, protein and dairy, but there is growing evidence of a positive relationship between the components of fruits and vegetables and bone health. In fact, adequate intake of some of these components, such as phytochemicals (e.g., carotenoids, and genistein aglycone), vitamin C and selenium, could improve BMD. Specifically, the study of Marini et al. found that beta-carotene slowed bone reabsorption, and genistein aglycone administration decreased levels of bone reabsorption markers (pyrrolidonyl aminopeptidase (PYR), telopeptide of type I collagen (CTX) and receptor activator of nuclear factor B (RANKL) and increased new bone formation markers (IGF-I and osteoprotegerin (OPG)) [18]. Furthermore, vitamin C has been associated with BMD in the femoral neck and lumbar spine [8][19]. Regarding selenium, higher levels were positively related to site-specific BMD [20]. Similarly, other diets rich in fruits and vegetables, such as DASH (Dietary Approaches to Stop Hypertension), reduced serum osteocalcin by 8–11% and CTX by 16–18% [6].
Table 1. Influence of key MedDiet foods on bone and muscle health.
Typical Foods of the Meddiet BMD Osteoporotic Fractures Strength Muscle Mass
EVOO + + + +
Vegetables and Fruits + + + +
Legumes + + Unknown Unknown
Grains + + Unknown +
Nuts Unknown Unknown + Unknown
Fish + + + +
Wine + + + Unknown
BMD (Density Mineral Bone) and EVOO (extra virgin olive oil).
Along the same lines, the dietary intake of OO has been positively associated with total, trabecular and cortical BMD [21]. Olive polyphenols have been shown to protect bone health via oxidative stress reduction and anti-inflammatory effects. A dose-dependent protective effect of oleuropein (a polyphenol from OO) has been discovered in a model of rats with bone loss [22]. Also, hydroxytyrosol, formed by the hydrolysis of oleuropein during the maturing of olives, could prevent osteopenia by increasing bone formation [23]. In this regard, olive polyphenols favor the growth and differentiation of pre-osteoblasts and decrease osteoclast formation [24][25][26][27]. In addition, Fernandez-Real et al. showed that a MedDiet enriched with VOO, compared with a walnut-enriched MedDiet and a low-fat diet for two years, had a positive effect on serum markers of bone formation and caused a reduction in the circulating concentration of markers of bone reabsorption [28].
Another phenolic compound that belongs to the group of phytoestrogens and is present in vegetables and abundant in red grapes and red wine is resveratrol (RES). This compound promotes the maturation of osteoblasts and slows down the formation of osteoclasts in vitro. Hence, RES has been related to the preservation of bone mass, microarchitecture and strength in rats [29]. In fact, moderate alcohol intake, specifically red wine, a typical component of the MedDiet, might prevent bone loss in older men, and a moderate intake of wine might do so in women [30][31].
In addition, moderate fish intake is a feature of the MedDiet. Fish contains numerous nutrients that have a beneficial effect on bones. Specifically, it is a source of high-quality protein, omega-3 fatty acids, vitamins A and D, and minerals such as selenium, calcium, iodine and zinc [12]. In fact, the recent review by Perna et al. indicates that fish has a positive impact on BMD mainly due to the anti-inflammatory effect of omega-3 fatty acids. In particular, DHA are positively related with bone mineral accumulation and with peak BMD in young men. DHA seems to be a vital constituent of healthy modeling bone because it accumulates in the osteoblast-rich periosteum of the femur in growing rats [32][33]. Moreover, omega-3 fatty acids favor duodenal calcium absorption and lead to decreased calcium excretion [32][34].
Also, the intake of legumes and cereals (grains) is high in the Mediterranean dietary pattern. These foods are rich in vitamin B, calcium and phytochemicals. Their adequate consumption has been related to higher BDM and decreased bone loss with aging. Therefore, the data suggest that legumes and grains may protect bone metabolism in humans [35][36].
In contrast to the Mediterranean dietary pattern, a higher adherence to pro-inflammatory dietary patterns, distinguished by its content in processed food, fats and red meat, has been linked to lower BMD and increased peripheral inflammation [7].

3. Osteoporotic Fractures

Different strategies to decrease the increase in fragility fractures have been sought. Among them, adherence to a healthy diet such as the MedDiet was linked to a lower rate of hip fractures [2][37]. This reduction in the number of hip fractures was also observed in Mediterranean population or Americans who follow the Mediterranean dietary pattern compared to the rate of fractures in the population of Northern Europe [2][38]. According to Haring et al., a lower risk of hip fractures was reported with higher adherence to the MedDiet in women aged 50–79 years in a post hoc analysis of longitudinal data from the United States Women’s Health Initiative (median follow-up of 15.9 years) [2]. Similarly, the EPIC (European Prospective Investigation into Cancer and Nutrition) study in men and women (N = 188,795 participants, 802 incident hip fractures) observed that a higher adherence to the MedDiet reduced the incidence of hip fractures by 7%, particularly in men [11]. Also, the meta-analysis of Malmir specified that higher adherence to the MedDiet was associated with a 21% decreased hip fracture risk [1].
To explain the inverse association between MedDiet adherence and hip fractures, whether or not type 2 diabetes mellitus (T2DM) and body mass index (BMI) mediated this relationship was analyzed. The state of systemic inflammation that encourages the development of chronic noncommunicable diseases such as OP, obesity and T2DM [39][40], could play a role. In fact, Cauley et al. observed that baseline markers of inflammation were higher among subjects who subsequently experienced an incident fracture [41]. However, Mitchell et al. reported a direct effect on hip fracture risk via pathways other than T2DM and BMI, yet they could not rule out the mediating effects of BMI and T2DM, even if their effects canceled each other out [42].
On the other hand, better MedDiet adherence in middle-aged women (45–65 years), with or without OP, was associated with a lower bone risk fracture [43]. However, the evidence of a protective effect of the MedDiet on total fracture risk has been contradictory. In fact, a small older French population study found that higher MedDiet adherence was associated with a nonsignificant reduced risk of fractures to the hip, spine and wrist [10].
Nevertheless, it is necessary to emphasize that causality has not been established by these studies, as they are not randomized trials; most are cross-sectional and observational. In addition, the effect of the MedDiet is possibly due to particular dietary components whose intake should be increased. For example, in the PREDIMED (Prevention with Mediterranean diet) trial, greater consumption of EVOO was associated with a lower risk of OP-related fractures in an older Mediterranean population at high cardiovascular risk [5]. Specifically, individuals in the highest tertile of EVOO consumption had a 51% lower risk of fractures than those in the lowest tertile. Total and standard OO intake has not been associated with fracture risk [5]. Therefore, EVOO is the best quality oil compared to other OOs. Indeed, EVOO has the highest amounts of bioactive and antioxidant components, such as polyphenols, with probable beneficial effects on bone metabolism [44]. In contrast, regular OO is more than 80% refined, with fewer antioxidant and anti-inflammatory compounds [5]. Also, fish, a source of omega-3 PUFA, has been inversely associated with hip fracture risk [45]. Other typical Mediterranean foods have been demonstrated to reduce the risk of fracture, such as legumes, cereals [36] and wine [43]. Also, high fruit and vegetable intake can give antioxidant power due to vitamins such as vitamin C. Specifically, this is required for collagen synthesis and osteoblast generation. In this regard, a higher vitamin C intake has been related to higher BMD at the femoral neck and lumbar spine and a lower fracture risk [46][47]. In addition, a dose–response relationship between fruit and vegetable intake and hip fracture has been described. Hence, consumption of fewer than five servings of fruit and vegetables per day was associated with higher rates of hip fracture [48]. Also, the combination of fruit and vegetables with fermented milk (yogurt or sour milk) was shown to decrease the rate of hip fracture [49].
In contrast, supplementing the diet with sugar does not promote bone health. In fact, a substudy of PREDIMED, PREDIMED-Reus detected that a higher dietary glycemic index and higher dietary glycemic load values could increase the risk of osteoporotic fracture [50].
On the other hand, Jennings et al. reported that the additive effects of individual components within the Mediterranean diet in a non-Mediterranean region have a greater effect on fracture incidence than the individual components of this diet [13].
In summary, different factors have to be considered. However, adherence to a Mediterranean dietary pattern with an adequate consumption of OO, preferably EVOO, fish, fruit and vegetables, avoiding high-glycemic-index sugars, could decrease the risk of fractures related to OP (Table 1).

This entry is adapted from the peer-reviewed paper 10.3390/nu15143224

References

  1. Malmir, H.; Saneei, P.; Larijani, B.; Esmaillzadeh, A. Adherence to Mediterranean diet in relation to bone mineral density and risk of fracture: A systematic review and meta-analysis of observational studies. Eur. J. Nutr. 2018, 57, 2147–2160.
  2. Haring, B.; Crandall, C.J.; Wu, C.; LeBlanc, E.S.; Shikany, J.M.; Carbone, L.; Orchard, T.; Thomas, F.; Wactawaski-Wende, J.; Li, W.; et al. Dietary Patterns and Fractures in Postmenopausal Women: Results From the Women’s Health Initiative. JAMA Int. Med. 2016, 176, 645.
  3. Pérez-Rey, J.; Roncero-Martín, R.; Rico-Martín, S.; Rey-Sánchez, P.; Pedrera-Zamorano, J.; Pedrera-Canal, M.; López-Espuela, F.; Lavado García, J.M. Adherence to a Mediterranean Diet and Bone Mineral Density in Spanish Premenopausal Women. Nutrients 2019, 11, 555.
  4. Gaffney-Stomberg, E. The Impact of Trace Minerals on Bone Metabolism. Biol. Trace Elem. Res. 2019, 188, 26–34.
  5. García-Gavilán, J.F.; Bulló, M.; Canudas, S.; Martínez-González, M.A.; Estruch, R.; Giardina, S.; Fitó, M.; Corella, D.; Ros, E.; Salas-Salvadó, J. Extra virgin olive oil consumption reduces the risk of osteoporotic fractures in the PREDIMED trial. Clin Nutr. 2018, 37, 329–335.
  6. Lin, P.H.; Ginty, F.; Appel, L.J.; Aickin, M.; Bohannon, A.; Garnero, P.; Barclay, D.; Svetkey, L.P. The DASH Diet and Sodium Reduction Improve Markers of Bone Turnover and Calcium Metabolism in Adults. J. Nutr. 2003, 133, 3130–3136.
  7. Movassagh, E.Z.; Vatanparast, H. Current Evidence on the Association of Dietary Patterns and Bone Health: A Scoping Review. Adv. Nutr. 2017, 8, 1–16.
  8. Wang, F.; Wang, N.; Gao, Y.; Zhou, Z.; Liu, W.; Pan, C.; Yin, P.; Yu, X.; Tang, M. β-Carotene suppresses osteoclastogenesis and bone resorption by suppressing NF-κB signaling pathway. Life Sci. 2017, 174, 15–20.
  9. Park, S.J.; Joo, S.E.; Min, H.; Park, J.K.; Kim, Y.; Kim, S.S.; Ahn, Y. Dietary Patterns and Osteoporosis Risk in Postmenopausal Korean Women. Osong. Public Health Res. Perspect. 2012, 3, 199–205.
  10. Feart, C.; Lorrain, S.; Ginder Coupez, V.; Samieri, C.; Letenneur, L.; Paineau, D.; Barberger-Gateau, P. Adherence to a Mediterranean diet and risk of fractures in French older persons. Osteoporos. Int. 2013, 24, 3031–3041.
  11. Benetou, V.; Orfanos, P.; Pettersson-Kymmer, U.; Bergström, U.; Svensson, O.; Johansson, I.; Berrino, F.; Tumino, R.; Borch, K.B.; Lund, E. Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporos. Int. 2013, 24, 1587–1598.
  12. Rivas Velasco, A. Adherencia a la Dieta Mediterránea y Salud Ósea. Nutr. Hosp. 2014, 29, 989–996.
  13. Jennings, A.; Cashman, K.D.; Gillings, R.; Cassidy, A.; Tang, J.; Fraser, W.; Dowling, K.G.; Hull, G.L.J.; Berendsen, A.A.M.; de Groot, L.C.P.G.M.; et al. A Mediterranean-like dietary pattern with vitamin D3 (10 µg/d) supplements reduced the rate of bone loss in older Europeans with osteoporosis at baseline: Results of a 1-y randomized controlled trial. Am. J. Clin. Nutr. 2018, 108, 633–640.
  14. Noori, M.; Jayedi, A.; Khan, T.A.; Moradi, S.; Shab-Bidar, S. Mediterranean dietary pattern and bone mineral density: A systematic review and dose-response meta-analysis of observational studies. Eur. J. Clin. Nutr. 2022, 76, 1657–1664.
  15. Chen, G.D.; Dong, X.W.; Zhu, Y.Y.; Tian, H.Y.; He, J.; Chen, Y.M. Adherence to the Mediterranean diet is associated with a higher BMD in middle-aged and elderly Chinese. Sci. Rep. 2016, 6, 25662.
  16. Zeng, F.F.; Xue, W.Q.; Cao, W.T.; Wu, B.H.; Xie, H.L.; Fan, F.; Zhu, H.L.; Chen, Y.M. Diet-quality scores and risk of hip fractures in elderly urban Chinese in Guangdong, China: A case–control study. Osteoporos. Int. 2014, 25, 2131–2141.
  17. Kontogianni, M.D.; Melistas, L.; Yannakoulia, M.; Malagaris, I.; Panagiotakos, D.B.; Yiannakouris, N. Association between dietary patterns and indices of bone mass in a sample of Mediterranean women. Nutrition 2009, 25, 165–171.
  18. Marini, H.; Bitto, A.; Altavilla, D.; Burnett, B.P.; Polito, F.; Di Stefano, V.; Minutoli, L.; Atteritano, M.; Levy, R.M.; D’Anna, R.; et al. Breast Safety and Efficacy of Genistein Aglycone for Postmenopausal Bone Loss: A Follow-Up Study. J. Clin. Endocrinol. Metab. 2008, 93, 4787–4796.
  19. Zeng, L.F.; Luo, M.H.; Liang, G.H.; Yang, W.Y.; Xiao, X.; Wei, X.; Yu, J.; Guo, D.; Chen, H.Y.; Pan, J.K.; et al. Can Dietary Intake of Vitamin C-Oriented Foods Reduce the Risk of Osteoporosis, Fracture, and BMD Loss? Systematic Review With Meta-Analyses of Recent Studies. Front. Endocrinol. 2020, 10, 844.
  20. Qu, Z.; Yang, F.; Yan, Y.; Hong, J.; Wang, W.; Li, S.; Jiang, G.; Yan, S. Relationship between Serum Nutritional Factors and Bone Mineral Density: A Mendelian Randomization Study. J. Clin. Endocrinol. Metab. 2021, 106, e2434–e2443.
  21. Roncero-Martín, R.; Aliaga Vera, I.; Moreno-Corral, L.; Moran, J.; Lavado-Garcia, J.; Pedrera-Zamorano, J.; Pedrera-Canal, M. Olive Oil Consumption and Bone Microarchitecture in Spanish Women. Nutrients 2018, 10, 968.
  22. Puel, C.; Coxam, V.; Davicco, M.J. Régime méditerranéen et ostéoporose. Méd. Sci. 2007, 23, 756–760.
  23. Puel, C.; Mardon, J.; Agalias, A.; Davicco, M.J.; Lebecque, P.; Mazur, A.; Horcajada, M.N.; Skaltsounis, A.L.; Coxam, V. Major Phenolic Compounds in Olive Oil Modulate Bone Loss in an Ovariectomy/Inflammation Experimental Model. J. Agric. Food Chem. 2008, 56, 9417–9422.
  24. Chin, K.Y.; Ima-Nirwana, S. Olives and Bone: A Green Osteoporosis Prevention Option. Int. J. Environ. Res. Public Health 2016, 13, 755.
  25. García-Martínez, O.; De Luna-Bertos, E.; Ramos-Torrecillas, J.; Ruiz, C.; Milia, E.; Lorenzo, M.L.; Jimenez, B.; Sánchez-Ortiz, A.; Rivas, A. Phenolic Compounds in Extra Virgin Olive Oil Stimulate Human Osteoblastic Cell Proliferation. PLoS ONE 2016, 11, e0150045.
  26. Hagiwara, K.; Goto, T.; Araki, M.; Miyazaki, H.; Hagiwara, H. Olive polyphenol hydroxytyrosol prevents bone loss. Eur. J. Pharmacol. 2011, 662, 78–84.
  27. Santiago-Mora, R.; Casado-Díaz, A.; De Castro, M.D.; Quesada-Gómez, J.M. Oleuropein enhances osteoblastogenesis and inhibits adipogenesis: The effect on differentiation in stem cells derived from bone marrow. Osteoporos. Int. 2011, 22, 675–684.
  28. Fernández-Real, J.M.; Bulló, M.; Moreno-Navarrete, J.M.; Ricart, W.; Ros, E.; Estruch, R.; Salas-Salvadó, J. A Mediterranean Diet Enriched with Olive Oil Is Associated with Higher Serum Total Osteocalcin Levels in Elderly Men at High Cardiovascular Risk. J. Clin. Endocrinol. Metab. 2012, 97, 3792–3798.
  29. Tousen, Y.; Ichimaru, R.; Kondo, T.; Inada, M.; Miyaura, C.; Ishimi, Y. The Combination of Soy Isoflavones and Resveratrol Preserve Bone Mineral Density in Hindlimb-Unloaded Mice. Nutrients 2020, 12, 2043.
  30. Marrone, J.A.; Maddalozzo, G.F.; Branscum, A.J.; Hardin, K.; Cialdella-Kam, L.; Philbrick, K.A.; Breggia, A.C.; Rosen, C.J.; Turner, R.T.; Iwaniec, U.T. Moderate alcohol intake lowers biochemical markers of bone turnover in postmenopausal women. Menopause 2012, 19, 974–979.
  31. Yin, J.; Winzenberg, T.; Quinn, S.; Giles, G.; Jones, G. Beverage-specific alcohol intake and bone loss in older men and women: A longitudinal study. Eur. J. Clin. Nutr. 2011, 65, 526–532.
  32. Perna, S.; Avanzato, I.; Nichetti, M.; D’Antona, G.; Negro, M.; Rondanelli, M. Association between Dietary Patterns of Meat and Fish Consumption with Bone Mineral Density or Fracture Risk: A Systematic Literature. Nutrients 2017, 9, 1029.
  33. Díaz-Castro, J.; Kajarabille, N.; Pulido-Moran, M.; Moreno-Fernandez, J.; Lopez-Frias, M.; Ochoa, J. Influence of Omega-3 Fatty Acids on Bone Turnover. In Omega-3 Fatty Acids; Springer: Cham, Switzerland, 2016; pp. 285–291.
  34. Orchard, T.S.; Ing, S.W.; Lu, B.; Belury, M.A.; Johnson, K.; Wactawski-Wende, J.; Jackson, R.D. The association of red blood cell n-3 and n-6 fatty acids with bone mineral density and hip fracture risk in the women’s health initiative. J. Bone Miner. Res. 2013, 28, 505–515.
  35. Pérez-López, F.R.; Chedraui, P.; Haya, J.; Cuadros, J.L. Effects of the Mediterranean diet on longevity and age-related morbid conditions. Maturitas 2009, 64, 67–79.
  36. Rivas, A.; Romero, A.; Mariscal-Arcas, M.; Monteagudo, C.; Feriche, B.; Lorenzo, M.L.; Olea, F. Mediterranean diet and bone mineral density in two age groups of women. Int. J. Food Sci. Nutr. 2013, 64, 155–161.
  37. Byberg, L.; Bellavia, A.; Larsson, S.C.; Orsini, N.; Wolk, A.; Michaëlsson, K. Mediterranean Diet and Hip Fracture in Swedish Men and Women: Mediterranean Diet And Hip Fracture in Swedish Men and Women. J. Bone Miner. Res. 2016, 31, 2098–2105.
  38. Dhanwal, D.K.; Dennison, E.M.; Harvey, N.C.; Cooper, C. Epidemiology of hip fracture: Worldwide geographic variation. Indian J. Orthop. 2011, 45, 15–22.
  39. Tamura, Y.; Omura, T.; Toyoshima, K.; Araki, A. Nutrition Management in Older Adults with Diabetes: A Review on the Importance of Shifting Prevention Strategies from Metabolic Syndrome to Frailty. Nutrients 2020, 12, 3367.
  40. Tuttle, C.S.L.; Thang, L.A.N.; Maier, A.B. Markers of inflammation and their association with muscle strength and mass: A systematic review and meta-analysis. Ageing Res. Rev. 2020, 64, 101185.
  41. Cauley, J.A.; Danielson, M.E.; Boudreau, R.M.; Forrest, K.Y.Z.; Zmuda, J.M.; Pahor, M.; Tylavsky, F.A.; Cummings, S.R.; Harris, T.B.; Newman, A.B.; et al. Inflammatory Markers and Incident Fracture Risk in Older Men and Women: The Health Aging and Body Composition Study. J. Bone Miner. Res. 2007, 22, 1088–1095.
  42. Mitchell, A.; Fall, T.; Melhus, H.; Wolk, A.; Michaëlsson, K.; Byberg, L. Is the effect of Mediterranean diet on hip fracture mediated through type 2 diabetes mellitus and body mass index? Int. J. Epidemiol. 2021, 50, 234–244.
  43. Palomeras-Vilches, A.; Viñals-Mayolas, E.; Bou-Mias, C.; Jordà-Castro, M.; Agüero-Martínez, M.; Busquets-Barceló, M.; Pujol-Busquets, G.; Carrion, C.; Bosque-Prous, M.; Serra-Majem, L.; et al. Adherence to the Mediterranean Diet and Bone Fracture Risk in Middle-Aged Women: A Case Control Study. Nutrients 2019, 11, 2508.
  44. Gimeno, E.; Castellote, A.I. The effects of harvest and extraction methods on the antioxidant content (phenolics, a-tocopherol, and b-carotene) in virgin olive oil. Food Chem. 2002, 78, 207–211.
  45. Sadeghi, O.; Djafarian, K.; Ghorabi, S.; Khodadost, M.; Nasiri, M.; Shab-Bidar, S. Dietary intake of fish, n-3 polyunsaturated fatty acids and risk of hip fracture: A systematic review and meta-analysis on observational studies. Crit. Rev. Food Sci. Nutr. 2019, 59, 1320–1333.
  46. Warensjö Lemming, E.; Byberg, L. Is a Healthy Diet Also Suitable for the Prevention of Fragility Fractures? Nutrients 2020, 12, 2642.
  47. Malmir, H.; Shab-Bidar, S.; Djafarian, K. Vitamin C intake in relation to bone mineral density and risk of hip fracture and osteoporosis: A systematic review and meta-analysis of observational studies. Br. J. Nutr. 2018, 119, 847–858.
  48. Byberg, L.; Bellavia, A.; Orsini, N.; Wolk, A.; Michaëlsson, K. Fruit and Vegetable Intake and Risk of Hip Fracture: A Cohort Study of Swedish Men and Women: Fruit and Vegetable Intake and Risk of Hip Fracture. J. Bone Miner. Res. 2015, 30, 976–984.
  49. Michaëlsson, K.; Wolk, A.; Lemming, E.W.; Melhus, H.; Byberg, L. Intake of Milk or Fermented Milk Combined With Fruit and Vegetable Consumption in Relation to Hip Fracture Rates: A Cohort Study of Swedish Women: Hip fracture rates and milk/fermented milk + fruit/vegetable consumption. J. Bone Miner. Res. 2018, 33, 449–457.
  50. García-Gavilán, J.F.; Bulló, M.; Camacho-Barcia, L.; Rosique-Esteban, N.; Hernández-Alonso, P.; Basora, J.; Martínez-González, M.A.; Estruchm, R.; Fitó, M.; Salas-Salvadó, J. Higher dietary glycemic index and glycemic load values increase the risk of osteoporotic fracture in the PREvención con DIeta MEDiterránea (PREDIMED)-Reus trial. Am. J. Clin. Nutr. 2018, 107, 1035–1042.
More
© Text is available under the terms and conditions of the Creative Commons Attribution (CC BY) license; additional terms may apply. By using this site, you agree to the Terms and Conditions and Privacy Policy.
This entry is offline, you can click here to edit this entry!
Video Production Service
Feedback