Dietary Pattern Analysis in Nutritional Science Research: A Review of Current Evidence Relating Dietary Patterns to Indices of Bone Health and Fracture Risk

The dietary pattern approach to nutritional science research may help to overcome some of the limitations associated with single nutrient studies such as colinearity of nutrients and inaccuracies of food composition databases. We provide a step by step outline of how to generate dietary patterns with commonly available statistical software and then examine their association with bone mineral density (measured by dual energy X-ray absorptiometry) using data collected from a well-characterised group of postmenopausal women as an example. We then review and summarise the current evidence relating dietary patterns to indices of bone health and fracture risk. Published research data shows that nutrient dense dietary patterns, characterised generally by high intakes of plant based foods, as well as lean protein or oily fish, have been consistently positively associated with surrogate markers of bone health (such as bone mineral density (BMD)) irrespective of population demographics. A small number of studies (predominantly prospective in nature) have progressed beyond surrogate markers to assess dietary pattern associations with incident fracture. Overall it is difficult to make recommendations either in support of or against specific dietary patterns or food groups to help maintain bone mass or prevent fracture given the marked heterogeneity of published studies. There is a requirement for consistency in future dietary pattern research with thorough consideration of potential confounding factors and recognition of the limitations of the general approach.