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 Sep;57(6):2147-2160. doi: 10.1007/s00394-017-1490-3. Epub 2017 Jun 21.


Purpose: We aimed to systematically review available data on the association between adherence to MD and BMD as well as risk of fractures and to summarize this information through a meta-analysis.

Methods: Previous studies in the field of adherence to MD in relation to BMD and risk of fracture were selected through searching PubMed, Scopus, ISI Web of Science and Google Scholar databases prior to June, 2016 using Mesh and non-Mesh relevant keywords.

Results: In the meta-analysis of four effect sizes, obtained from three studies, we found that adherence to MD was associated with a 21% reduced risk of hip fracture (overall RR 0.79; 95% CIs 0.72-0.87). Adherence to MD was positively associated with lumber spine's (mean difference of BMD comparing highest and lowest categories of MD score 0.12; 95% CI 0.06-0.19 g/cm2), femoral neck (0.10; 0.06-0.15 g/cm2) and total hip (0.11; 0.09-0.14 g/cm2) BMD. Meta-regression of included observational studies revealed a significant inverse linear association between Mediterranean diet score and risk of hip fracture, such that one unit increase in the score of Mediterranean diet was associated with a reduction in the risk of hip fracture (RR 0.95, 95% CI 0.92-0.98 p = 0.01).

Conclusion: Adherence to MD was associated with a reduced risk of fracture as well as with a higher mean BMD.

Keywords: Bone mineral density; Fracture; Mediterranean diet; Meta-analysis; Systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Bone Density / physiology*
  • Diet, Mediterranean*
  • Female
  • Femur Neck
  • Fractures, Bone / epidemiology*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors