Mediterranean Diet is Associated with Bone Mineral Density in Premenopausal Women

by | Apr 8, 2019 | 2019, Bone Health, Women's Health

Written by Angeline A. De Leon, Staff Writer. This cross-sectional study found that higher adherence to a Mediterranean-style diet was significantly associated with improved bone density.

Mediterranean DietIn the study of bone health, the majority of research studies have focused on the protective role of calcium and vitamin D 1, particularly for children and adolescents. Older adults, however, face relatively higher risk of degenerative bone diseases, with higher rates of osteoporosis among postmenopausal women 2. Osteoporosis occurs when bone density decreases, resulting in weaker bones and higher risk of fracture. While factors such as genetics, hormones, and physical activity levels may influence development of osteoporosis 3, Mediterranean countries appear to have lower incidence rates of osteoporosis 4, a phenomenon that researchers speculate may be in part attributable to their diet. The Mediterranean diet is well-known for its emphasis on high intake of fruits, vegetables, fish, and unsaturated fats such as olive oil, and previous studies suggest the beneficial effects of these dietary components for bone health 5. However, the role of a traditional Mediterranean diet in preventing risk of bone fracture is not yet entirely clear 6. In a 2019 study 7 published in Nutrients, researchers in Spain examined whether adherence to a Mediterranean diet would influence bone mineral density in a population of premenopausal women.

A total of 442 premenopausal women (mean age = 42.73 +/- 6.7 years) reporting no history of low-trauma fractures were enrolled in a cross-sectional study. The Food Frequency Questionnaire (FFQ) was administered to assess dietary intake of carbohydrates, protein, fat, calcium, and vitamin D, and adherence to a Mediterranean dietary pattern was evaluated using an 11-item questionnaire measuring intake of fruits, vegetables, fish, olive oil, etc. A total MedDiet (MD) Score was calculated, and participants were stratified as having low (<29), medium, (>29 and <32), or high (<32) adherence scores. Bone mineral density (BMD) was measured at several areas (phalanx of non-dominant hand, femoral neck, hip, lumbar spine, and non-distant distal forearm) using a combination of ultrasound techniques (quantitative bone ultrasound, QUS; dual energy X-ray absorptiometry, DXA; and peripheral quantitative computed tomography, pQCT).

Findings revealed that higher MD score was positively associated with BMD, total volumetric BMD, trabecular volumetric BMD, and cortical bone density BMD (p < 0.05 for all). In addition, regression analyses showed that MD score was positively correlated with femoral neck BMD (β = 0.114, p = 0.010), volumetric BMD total density (β = 0.119, p = 0.036), volumetric BMD trabecular (spongy bone tissue) density (β = 0.122, p = 0.032), and volumetric BMD cortical density (β = 0.122, p = 0.032).

Overall results indicate that higher adherence to a Mediterranean-style diet is indeed associated with increased bone mineral density, as assessed by various ultrasound-based techniques, in premenopausal women. Findings are in line with a recent meta-analysis reporting a link between the Mediterranean diet and BMD of the spine and femoral neck, as well as about a 20% decrease in risk of fracture 8. Findings also corroborate evidence from prior research showing an association between dietary intake of olive oil and total, trabecular, and cortical BMD 9. Thus, researchers conclude that dietary intervention, not just in the form of supplementation with vitamins such as calcium and vitamin D, but through adoption of a healthier, more nutrient-dense overall diet like the Mediterranean diet, may effectively support bone health and potentially prevent osteoporosis. A limitation of the study involves the use of a cross-sectional design which precludes establishment of a direct cause-and-effect relationship. Given the various means to measure MD adherence 10, it would also be beneficial to replicate present findings using alternative or supplementary MD questionnaires and to examine the transferability of results to clinical populations with osteoporosis and/or other bone diseases. 

Source: Perez-Rey J, Roncero-Martin R, Rico-Martin S, et al. Adherence to a Mediterranean diet and bone mineral density in Spanish premenopausal women. Nutrients. 2019; 11: 555. DOI: 10.3390/nu11030555.

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

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Posted April 8, 2019. 

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