Original Article

Major dietary patterns and osteoporosis risk in postmenopausal Iranian women


Background: As the global elderly population increases,the prevalence of osteoporosis and the incidence of osteoporosis-related fractures are becoming a major social and medical concern in both developed and developing countries. Therefore, the objective of the present study was to examine association dietary pattern and bone health in postmenopausal women.
Materials and Methods: In this study, 254 postmenopausal women aged 46 to 78 years were examined. Body composition measured by Body Composition Analyzer Physical activity using the short form of physical activity questionnaire (IPAQ) was performed Bone mineral density was measured by DEXA method. Major dietary patterns were determined using factor analysis on 27 foods groups using a valid and reliable, 147-item semi-quantitative food frequency questionnaire (FFQ)  The major dietary patterns were identified by factor analysis (PCA) method.
Results: Three dietary patterns including The Mediterranean diet, Traditional and unhealthy were identified. These three dietary patterns explained 30.45 % of total variance in dietary intakes.  Our results showed that higher adherence score to a " Mediterranean " dietary pattern was positively associated with Zscore L2_L4 lumbar  spine (0.05> P). Furthermore, logistic regression results showed that Mediterranean dietary pattern reduces the risk of osteopenia/ osteoporosis (OR = 0.75, 95%CI: 0.58 -0.96). However, Traditional (OR = 0.97, 95%CI: 0.76 -1.24) and Unhealthy (OR = 1.19, 95%CI: 0.93 -1.52) dietary patterns were no  association with risk of osteopenia/ osteoporosis
Conclusion: It seems Mediterranean dietary pattern, has a protective association against the risk of osteopenia/ osteoporosis in postmenopausal women

1. Kawalkar AC. A Comprehensive Review on Osteoporosis. Journal of Trauma. 2015;10(1):3-12.
2. Si L, Winzenberg T, Jiang Q, Chen M, Palmer A. Projection of osteoporosis-related fractures and costs in China: 2010–2050. Osteoporosis International. 2015:1-9.
3. Eastell R, O'Neill TW, Hofbauer LC, Langdahl B, Reid IR, Gold DT, et al. Postmenopausal osteoporosis. Nature reviews Disease primers. 2016;2:16069.
4. Giusti A, Bianchi G. Treatment of primary osteoporosis in men. Clinical interventions in aging. 2015;10:105.
5. Sforza E, Saint Martin M, Thomas T, Collet P, Garet M, Barthelemy JC, et al. Risk factors of osteoporosis in healthy elderly with unrecognized obstructive sleep apnea: role of physical activity. Sleep medicine. 2016;22:25-32.
6. Greco EA, Donini LM, Lenzi A, Migliaccio S. Obesity and Osteoporosis. Multidisciplinary Approach to Obesity: Springer; 2015. p. 83-8.
7. Nepal NKS. Biological Interaction of Stress and Osteoporosis. International Journal of Pharmaceutical & Biological Archive. 2015;5(5).
8. Guo JL, Qu CY, Bai F, Ma JH, Chai YF. [Relations between alcoholism and osteoporosis or femoral head necrosis]. Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi. 2013;34(7):732-5.
9. Christos KF, Maria PE, Ioanna PV, Polina P, Ioannis K, Sofia D, et al. Smoking is associated with osteoporosis development in Primary care population. American Journal of Nursing. 2015;4(2-1):96-101.
10. Conti V, Russomanno G, Corbi G, Toro G, Simeon V, Filippelli W, et al. A Polymorphism at the Translation Start Site of the Vitamin D Receptor Gene Is Associated with the Response to Anti-Osteoporotic Therapy in Postmenopausal Women from Southern Italy. International journal of molecular sciences. 2015;16(3):5452-66.
11. Chen Y, Xiang J, Wang Z, Xiao Y, Zhang D, Chen X, et al. Associations of Bone Mineral Density with Lean Mass, Fat Mass, and Dietary Patterns in Postmenopausal Chinese Women: A 2-Year Prospective Study. PloS one. 2015;10(9):e0137097.
12. Hardcastle A, Aucott L, Fraser W, Reid D, Macdonald H. Dietary patterns, bone resorption and bone mineral density in early post-menopausal Scottish women. European journal of clinical nutrition. 2011;65(3):378-85.
13. Kant AK. Dietary patterns and health outcomes. Journal of the American Dietetic Association. 2004;104(4):615-35.
14. Tucker KL, Chen H, Hannan MT, Cupples LA, Wilson PW, Felson D, et al. Bone mineral density and dietary patterns in older adults: the Framingham Osteoporosis Study. Am J Clin Nutr. 2002;76(1):245-52.
15. Shin S, Joung H. A dairy and fruit dietary pattern is associated with a reduced likelihood of osteoporosis in Korean postmenopausal women. The British journal of nutrition. 2013;110(10):1926-33.
16. Kontogianni MD, Melistas L, Yannakoulia M, Malagaris I, Panagiotakos DB, Yiannakouris N. Association between dietary patterns and indices of bone mass in a sample of Mediterranean women. Nutrition. 2009;25(2):165-71.
17. Zhang X, Shu X-O, Li H, Yang G, Li Q, Gao Y-T, et al. Prospective cohort study of soy food consumption and risk of bone fracture among postmenopausal women. Archives of Internal Medicine. 2005;165(16):1890-5.
18. de Franca NA, Camargo MB, Lazaretti-Castro M, Peters BS, Martini LA. Dietary patterns and bone mineral density in Brazilian postmenopausal women with osteoporosis: a cross-sectional study. Eur J Clin Nutr. 2016;70(1):85-90.
19. Rivas A, Romero A, Mariscal-Arcas M, Monteagudo C, Feriche B, Lorenzo ML, et al. Mediterranean diet and bone mineral density in two age groups of women. International journal of food sciences and nutrition. 2013;64(2):155-61.
20. Saura-Calixto F, Goni I. Definition of the Mediterranean diet based on bioactive compounds. Critical reviews in food science and nutrition. 2009;49(2):145-52.
21. Rivas A, Romero A, Mariscal-Arcas M, Monteagudo C, Feriche B, Lorenzo ML, et al. Mediterranean diet and bone mineral density in two age groups of women. Int J Food Sci Nutr. 2013;64(2):155-61.
22. Gaddini GW, Turner RT, Grant KA, Iwaniec UT. Alcohol: A Simple Nutrient with Complex Actions on Bone in the Adult Skeleton. Alcoholism, clinical and experimental research. 2016;40(4):657-71.
23. Feskanich D, Willett WC, Stampfer MJ, Colditz GA. Protein consumption and bone fractures in women. American journal of epidemiology. 1996;143(5):472-9.
24. Corwin RL, Hartman TJ, Maczuga SA, Graubard BI. Dietary saturated fat intake is inversely associated with bone density in humans: analysis of NHANES III. The Journal of nutrition. 2006;136(1):159-65.
25. Carbone LD, Bush AJ, Barrow KD, Kang AH. The relationship of sodium intake to calcium and sodium excretion and bone mineral density of the hip in postmenopausal African-American and Caucasian women. Journal of bone and mineral metabolism. 2003;21(6):415-20.
26. de Jonge EA, Rivadeneira F, Erler NS, Hofman A, Uitterlinden AG, Franco OH, et al. Dietary patterns in an elderly population and their relation with bone mineral density: the Rotterdam Study. Eur J Nutr. 2016.
27. Analyzers, T.s.p.B.C. BODY COMPOSITION ANALYZER; BC-418. INSTRUCTION MANUAL. March, 2015; Available from: http://www.tanita.com/en/bc-418/.
28. Asghari G, Rezazadeh A, Hosseini-Esfahani F, Mehrabi Y, Mirmiran P, Azizi F. Reliability, comparative validity and stability of dietary patterns derived from an FFQ in the Tehran Lipid and Glucose Study. The British journal of nutrition. 2012;108(6):1109-17.
29. IPAQ Research Committee. Guideline for data processing and analysis of the
international physical activity questionnaire (IPAQ), short form; 2005, Available from: http://www.ipaq.ki.se [accessed 18.01.10].
30. Lee PH, Macfarlane DJ, Lam TH, Stewart SM. Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF): a systematic review. The international journal of behavioral nutrition and physical activity. 2011;8:115.
31. Irani AD, Poorolajal J, Khalilian A, Esmailnasab N, Cheraghi Z. Prevalence of osteoporosis in Iran: A meta-analysis. Journal of Research in Medical Sciences. 2013;18(9):759-66.
32. Bagheri P, Haghdoost A, DORTAJ RE, Halimi L, Vafaei Z, Farhangnia M, et al. ULTRA ANALYSIS OF PREVALENCE OF OSTEOPOROSIS IN IRANIAN WOMEN. 2011.
33. Benetou V, Orfanos P, Pettersson-Kymmer U, Bergström U, Svensson O, Johansson I, et al. Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporosis International. 2013;24(5):1587-98.
34. Cashman KD. Diet, nutrition, and bone health. J Nutr. 2007;137(11 Suppl):2507s-12s.
35. Schulman RC, Weiss AJ, Mechanick JI. Nutrition, bone, and aging: an integrative physiology approach. Current osteoporosis reports. 2011;9(4):184-95.
36. García-Martínez O, Rivas A, Ramos-Torrecillas J, De Luna-Bertos E, Ruiz C. The effect of olive oil on osteoporosis prevention. International journal of food sciences and nutrition. 2014;65(7):834-40.
37. Puel C, Mardon J, Agalias A, Davicco M-J, Lebecque P, Mazur A, et al. Major phenolic compounds in olive oil modulate bone loss in an ovariectomy/inflammation experimental model. Journal of agricultural and food chemistry. 2008;56(20):9417-22.
38. Ishimi Y, Miyaura C, Ohmura M, Onoe Y, Sato T, Uchiyama Y, et al. Selective effects of genistein, a soybean isoflavone, on B-lymphopoiesis and bone loss caused by estrogen deficiency. Endocrinology. 1999;140(4):1893-900.
39. Sanchez-Villegas A, Bes-Rastrollo M, Martinez-Gonzalez M, Serra-Majem L. Adherence to a Mediterranean dietary pattern and weight gain in a follow-up study: the SUN cohort. International journal of obesity. 2006;30(2):350-8.
40. Esposito K, Kastorini C-M, Panagiotakos DB, Giugliano D. Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Metabolic syndrome and related disorders. 2011;9(1):1-12.
41. Mattes RD, Kris-Etherton PM, Foster GD. Impact of peanuts and tree nuts on body weight and healthy weight loss in adults. The Journal of nutrition. 2008;138(9):1741S-5S.
42. Harland JI, Garton LE. Whole-grain intake as a marker of healthy body weight and adiposity. Public health nutrition. 2008;11(06):554-63.
43. Razquin C, Martinez J, Martinez-Gonzalez M, Mitjavila M, Estruch R, Marti A. A 3 years follow-up of a Mediterranean diet rich in virgin olive oil is associated with high plasma antioxidant capacity and reduced body weight gain. European journal of clinical nutrition. 2009;63(12):1387-93.
44. Thompson WG, Holdman NR, Janzow DJ, Slezak JM, Morris KL, Zemel MB. Effect of Energy‐Reduced Diets High in Dairy Products and Fiber on Weight Loss in Obese Adults. Obesity research. 2005;13(8):1344-53.
45. Hansen J, Jacobsen R, Astrup A, editors. Effect of short-term high dietary calcium intake on 24-h energy expenditure, fat oxidation, and fecal fat excretion. European Congress on Obesity, International Journal of Obesity; 2004.
IssueVol 2, No 2 (Spring 2016) QRcode
SectionOriginal Article(s)
Bone mineral density Dietary patterns postmenopauasl women Mediterranean diet osteoporosis

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How to Cite
Moradi S, Khorrami-nezhad L, Yekaninejad MS, Mirzaei K, Maghbooli Z. Major dietary patterns and osteoporosis risk in postmenopausal Iranian women. J Nutr Sci & Diet. 2016;2(2).