title: Fruit and vegetable intake and bone health in women aged 45 years and over: a systematic review.
abstract: High fruit and vegetable intake may be associated with improved bone status among women aged ≥ 45 years. This is the first systematic review that specifically assessed this association and identified research gaps. The benefits of fruit and vegetables (F&V) on bone health remain unclear. Further studies are needed.
  
  
  BACKGROUND
  F&V have several components that are beneficial to bones. Some studies report that high F&V intake is associated with improved bone status in middle aged and aged women; however, findings are inconsistent. The objective was to systematically review observational and interventional studies that investigated the effects of F&V intake on incidence of osteoporotic fractures, bone mineral density (BMD), and bone turnover markers (BTM) in women aged ≥ 45 years and to identify potential research gaps.
  
  
  METHODS
  Electronic databases were searched, and peer-reviewed manuscripts published in English, with F&V intake as a main dietary exposure, were included. Data selection, extraction, and evaluation of risk of bias were performed independently by two reviewers.
  
  
  RESULTS
  Eight studies were included. One cohort study reported cross-sectional as well as longitudinal data. There was significant between-study heterogeneity in design, definition, and amount of F&V intake, outcomes, analyses, and reporting of results. Two studies had low, two had moderate, and four had high risk of bias. Among reports with low or moderate risk of bias, two cross-sectional analyses reported positive associations between F&V intake and BMD of the forearm, lumbar spine, or total hip, whereas one randomized controlled trial and two prospective cohort analyses reported no effects. One trial reported no associations between F&V and BTM.
  
  
  CONCLUSIONS
  Based on limited evidence, the benefits of F&V on bone health remain unclear for women aged ≥ 45 years. Further studies with low risk of bias are needed.
authors.affiliation: Women's Health and Osteoporosis Programs, University Health Network, 200 Elizabeth Street, 7 Eaton North-228-A, Toronto, ON M5G 2C4, Canada. maryam.hamidi@utoronto.ca
authors.forename: M
authors.initials: M
authors.lastname: Hamidi
authors.forename: B A
authors.initials: BA
authors.lastname: Boucher
authors.forename: A M
authors.initials: AM
authors.lastname: Cheung
authors.forename: J
authors.initials: J
authors.lastname: Beyene
authors.forename: P S
authors.initials: PS
authors.lastname: Shah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015982:Bias; D015519:Bone Density / Q000502:physiology; D016723:Bone Remodeling / Q000502:physiology; D004032:Diet; D005260:Female; D005638:Fruit; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000503:physiopathology / Q000517:prevention & control*; D058866:Osteoporotic Fractures / Q000503:physiopathology / Q000517:prevention & control; D014675:Vegetables