title: Dietary patterns explaining differences in bone mineral density and hip structure in the elderly: the Rotterdam Study.
abstract: Evidence on the association between dietary patterns, measures of hip bone geometry, and subsequent fracture risk are scarce.
  
  
  
  The objective of this study was to evaluate whether dietary patterns that explain most variation in bone mineral density (BMD) and hip bone geometry are associated with fracture risk.
  
  
  
  We included 4028 subjects aged ≥55 y from the Rotterdam study. Intake of 28 food groups was assessed with the use of food-frequency questionnaires. BMD, bone width, section modulus (SM; reflecting bending strength) and cortical buckling ratio (BR; reflecting bone instability) were measured with the use of dual-energy X-ray absorptiometry. BMD and geometry-specific dietary patterns were identified with the use of reduced rank regression. Fracture data were reported by general practitioners (median follow-up 14.8 y).
  
  
  
  We identified 4 dietary patterns. Of the 4, we named 2 patterns "fruit, vegetables, and dairy" and "sweets, animal fat, and low meat," respectively. These 2 patterns were used for further analysis. Independently of confounders, adherence to the fruit, vegetables, and dairy pattern was associated with high BMD, high SM, low BR, and low risk of fractures [HR (95% CI) for osteoporotic fractures: 0.90 (0.83, 0.96); for hip fractures: 0.85 (0.81, 0.89) per z score of dietary pattern adherence]. Adherence to the sweets, animal fat, and low meat pattern was associated with high bone width, high SM, high BR, and high risk of fractures [HR (95% CI) for osteoporotic fractures: 1.08 (1.00, 1.06); for hip fractures: 1.06 (1.02, 1.12) per z score].
  
  
  
  The fruit, vegetables, and dairy pattern might be associated with lower fracture risk because of high BMD, high bending strength, and more stable bones. The sweets, animal fat, and low meat pattern might be associated with higher fracture risk because of widened, unstable bones, independently of BMD. Dietary recommendations associated with bone geometry in addition to BMD might influence risk of fractures.
authors.affiliation: Department of Epidemiology and.|Department of Internal Medicine, Erasmus Medical University Centre, Rotterdam, Netherlands.
authors.forename: Ester Al
authors.initials: EA
authors.lastname: de Jonge
authors.affiliation: Department of Epidemiology and j.c.kiefte-dejong@erasmusmc.nl.|Department of Global Public Health, Leiden University College, The Hague, Netherlands.
authors.forename: Jessica C
authors.identifier: 0000-0002-8136-0918
authors.initials: JC
authors.lastname: Kiefte-de Jong
authors.affiliation: Department of Epidemiology and.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Epidemiology and.|Department of Internal Medicine, Erasmus Medical University Centre, Rotterdam, Netherlands.
authors.forename: André G
authors.initials: AG
authors.lastname: Uitterlinden
authors.affiliation: Department of Epidemiology and.|Department of Internal Medicine, Erasmus Medical University Centre, Rotterdam, Netherlands.|Inspectorate for Health Care, Utrecht, Netherlands.
authors.forename: Brenda Ct
authors.initials: BC
authors.lastname: Kieboom
authors.affiliation: Department of Epidemiology and.
authors.forename: Trudy
authors.identifier: 0000-0003-2830-6813
authors.initials: T
authors.lastname: Voortman
authors.affiliation: Department of Epidemiology and.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.affiliation: Department of Internal Medicine, Erasmus Medical University Centre, Rotterdam, Netherlands.
authors.forename: Fernando
authors.identifier: 0000-0001-9435-9441
authors.initials: F
authors.lastname: Rivadeneira
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density; D001842:Bone and Bones / Q000378:metabolism; D004032:Diet; D004034:Diet Surveys; D005247:Feeding Behavior; D005260:Female; D005272:Femur Neck / Q000378:metabolism; D006615:Hip; D006620:Hip Fractures / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D058866:Osteoporotic Fractures; D012307:Risk Factors
keywords: dietary patterns; elderly; fractures; hip bone macro geometry; reduced rank regression