title: Low-fat, increased fruit, vegetable, and grain dietary pattern, fractures, and bone mineral density: the Women's Health Initiative Dietary Modification Trial.
abstract: BACKGROUND
  The effects of dietary changes on osteoporosis, low bone density, and frequent falls are unestablished.
  
  
  OBJECTIVE
  We assessed the effect of the Women's Health Initiative Dietary Modification low-fat and increased fruit, vegetable, and grain intervention on incident hip, total, and site-specific fractures and self-reported falls, and, in a subset, on bone mineral density (BMD).
  
  
  METHODS
  Postmenopausal women (n = 48,835) aged 50-79 y (18.6% of minority race-ethnicity) were randomly assigned to receive the Dietary Modification intervention (40%, n = 19,541) (daily goal: < or =20% of energy as fat, > or =5 servings of vegetables and fruit, and > or =6 servings of grains) or to a comparison group that received no dietary changes (60%; n = 29,294).
  
  
  RESULTS
  After a mean 8.1 y of follow-up, 215 women in the intervention group and 285 women in the comparison group (annualized rate: 0.14% and 0.12%, respectively) experienced a hip fracture (hazard ratio: 1.12; 95% CI: 0.94, 1.34; P = 0.21). The intervention group (n = 5423; annualized rate: 3.44%) had a lower rate of reporting > or =2 falls than did the comparison group (n = 8695; annualized rate: 3.67%) (HR: 0.92; 95% CI: 0.89, 0.96; P < 0.01). There was a significant interaction according to hormone therapy use; those in the comparison group receiving hormone therapy had the lowest incidence of hip fracture. In a subset of 3951 women, hip BMD at years 3, 6, and 9 was 0.4-0.5% lower in the intervention group than in the comparison group (P = 0.003).
  
  
  CONCLUSIONS
  A low-fat and increased fruit, vegetable, and grain diet intervention modestly reduced the risk of multiple falls and slightly lowered hip BMD but did not change the risk of osteoporotic fractures. This trial was registered at clinicaltrials.gov as NCT00000611.
authors.affiliation: Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA 98019, USA. amctiern@fhcrc.org
authors.forename: Anne
authors.initials: A
authors.lastname: McTiernan
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
authors.forename: LieLing
authors.initials: L
authors.lastname: Wu
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Rodabough
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Watts
authors.forename: Frances
authors.initials: F
authors.lastname: Tylavsky
authors.forename: Ruth
authors.initials: R
authors.lastname: Freeman
authors.forename: Susan
authors.initials: S
authors.lastname: Hendrix
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jackson
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000368:Aged; D015519:Bone Density; D018752:Diet, Fat-Restricted; D002523:Edible Grain; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology / Q000517:prevention & control*; D005638:Fruit; D006620:Hip Fractures / Q000453:epidemiology; D020249:Hormone Replacement Therapy; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control*; D010349:Patient Compliance; D016016:Proportional Hazards Models; D016103:Spinal Fractures / Q000453:epidemiology; D014675:Vegetables