Plant-Based Diets Protective Against Osteoporosis Among Older Adults, Women

Plant-based dietary patterns have a significant protective effect on osteoporosis among older adults and women.

Older individuals, especially women, who had higher consumption of healthy plant-based foods were at lower risk for osteoporosis, according to study findings published in Osteoporosis International.

Between 2019 and 2021, individuals aged older than 60 years were enrolled in the study from 9 communities in China. Study participants responded to a questionnaire about demographic characteristics and dietary habits and underwent skeletal muscle mass evaluation by an HBF-701 body composition analyzer.

Osteoporosis was defined by heel ultrasound, based on a T-score of 2.5 or lesser.

A total of 9613 were included in the study population, of whom 1848 (19.2%) had osteoporosis; 62.8% were women and were aged a mean of 68.7±5.80 years. The average body mass index (BMI) was 25.1±3.29; 37.7% had hypertension; 19.4% had diabetes; and 12.2% had a history of fracture.

Stratified by quartiles of the plant-based diet index (PDI) score, significant group differences in sex, income, physical activity, estimated bone mineral density, smoking, drinking, diabetes, and hypertension were observed (all P £.039).

[A] healthy plant-based dietary pattern was associated with a lower risk of osteoporosis, while an unhealthy plant-based dietary pattern was associated with a higher risk.

After adjusting for disease history and other risk factors, risk for osteoporosis was lower among individuals in the fourth (adjusted odds ratio [aOR], 0.80; 95% CI, 0.69-0.93) and third (aOR, 0.80; 95% CI, 0.69-0.92) quartiles for PDI compared with the first quartile (P =.001).

Stratified by type of plants, osteoporosis risk was decreased with consumption levels of healthy plants in the fourth (aOR, 0.64), third (aOR, 0.74), and second (aOR, 0.78) quartiles compared with the first quartile (P <.001), and increased with consumption levels of unhealthy plants in the fourth (aOR, 1.42), third (aOR, 1.30), and second (aOR, 1.21) quartiles compared with the first quartile (P <.001).

In subgroup analyses, no significant interactions were observed between subgroups and plant-based dietary indices in risk for osteoporosis, except for the effect of healthy plant foods on osteoporosis risk on the basis of sex (P =.021) and age (P =.028).

These interactions indicated that consuming more healthy plant foods had a greater beneficial effect in preventing osteoporosis among women and those older than 80 years compared with men aged 80 years and younger.

The foods that had the most beneficial effects were whole grains, fresh fruits, fresh vegetables, nuts, legumes, and tea whereas the unhealthiest foods were refined grains, sugary drinks, and desserts.

The study may have been limited by the food questionnaire, which contained a limited number of food groups and the definition of osteoporosis.

The study authors concluded, “[A] healthy plant-based dietary pattern was associated with a lower risk of osteoporosis, while an unhealthy plant-based dietary pattern was associated with a higher risk.”


Hu J, Li Y, Wang Z, et al. Association of plant‑based dietary patterns with the risk of osteoporosis in community‑dwelling adults over 60 years: a cross‑sectional study. Osteoporos Int. Published online March 1, 2023. doi:10.1007/s00198-023-06700-2