A new study from the Women’s Health Initiative (WHI) found that an alternate Mediterranean diet prevents fractures. A total of 93,676 women were enrolled in the WHI study. They were between 50 and 79 years old. Recruitment into the study took place between October 1, 1993 to December 31, 1998. The study had to be abruptly stopped in 2002. There were adverse effects with respect to hormone replacement therapy. But to examine bone health and fractures the study went on for a total of 15 years. It ended on August 29, 2014.
Food frequency questionnaires were used. This allowed the researchers to assess the nutritional intake of the participants. Four different food intake patterns of the participants were identified:
- The alternate Mediterranean diet including 9 diet categories
- Healthy Eating Index 2010: 100-point measure of 12 food components
- Alternate Healthy Eating Index 2010: consisting of 11 items
- Dietary Approaches to Stop Hypertension (DASH) diet: 8 components
Results of WHI study: Mediterranean Diet prevents fractures
90,014 participants were included in the analysis with an average age of 63.6 years. Over 15.9 years 2,121 cases of hip fractures occurred. In addition 28,718 cases of fractures overall occurred as well. Women who scored in the highest 20% of adhering to an alternate Mediterranean diet were used as a comparison group. It was these women who correlated best to having less hip fractures. They had a 20% less hip fractures when compared to control groups. This result was statistically highly significant. What allowed statistical significance? Large numbers of patients and the long observation period.
The researchers attempted to correlate reduction of fractures in other areas to any of the diets. However, no correlation could be found. Not with the alternate Mediterranean diet or others. Similarly, the Healthy Eating Index 2010 diet and the DASH diet were suggestive of lowering hip fractures. But this small effect did not reach statistical significance. The alternate Healthy Eating Index 2010 diet did not reduce hip fractures or other fractures.
Discussion why Mediterranean Diet prevents fractures
Bone metabolism is complex. It includes several dietary factors as discussed in this blog. I explained in it that vitamin D3 is needed for absorption of calcium. It is also needed for calcium deposition into bone together with vitamin K2. Exercise was also found useful in prevention of osteoporosis. This was helped by calcium, vitamin K2 and vitamin D3 taken as supplements. Vitamin K2 was also found to prevent heart attacks and strokes.This is because calcium is moved from the arterial walls into the bone. Bone fractures are diminished by vitamin K2 as well.
Conclusion that Mediterranean Diet prevents fractures
The Mediterranean diet is a well-balanced, healthy diet. It provides all of these nutrients mentioned above. The authors did not mentioned minerals and vitamins in any of the diets. In my opinion this diet inadvertently provided vitamin K2, vitamin D3 and calcium. As stated these ingredients are needed to prevent osteoporosis. Here is a review that explains why the Mediterranean diet is good for the heart and the bone. It is healthy, because multiple essential nutrients are contained in it. And it is a balanced diet. This very likely is the reason why osteoporosis and hip fractures were prevented in the WHI study. It is possible that taking supplements would have prevented other fractures as well.
Postmenopausal women need to pay attention to their diet. Eating a balanced Mediterranean diet is best. They also need to exercise regularly. And perhaps they should take these necessary supplements as well. This will prevent fractures. But it also prevents heart attacks and strokes.