Osteoporosis International

, Volume 22, Issue 6, pp 1681–1693 | Cite as

Fruit and vegetable intake and bone health in women aged 45 years and over: a systematic review

  • M. Hamidi
  • B. A. Boucher
  • A. M. Cheung
  • J. Beyene
  • P. S. Shah



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.


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.


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.


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.


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.


Aging Bone Bone mineral density Bone turnover markers Fractures Fruit and vegetables Nutrition Osteoporosis Women 



We sincerely thank Ms. Elizabeth Uleryk for her assistance in developing and executing the search strategy as well as Dr. Kyarash Safakish (MD) for his review of excluded citations based on titles and abstracts to ensure all citations met the exclusion criteria.


MH was involved in project conception, development of review protocol, and study oversight and wrote the initial draft. BAB, PSS, and AMC, respectively, were all involved in the design and execution of the review and made substantial revisions to the manuscript. AMC provided advice and interpreted findings on bone health, BAB on nutrition, and PSS, JB, and AMC on conducting systematic reviews and meta-analysis. MH and PSS reviewed the selected full-text articles and determined the risk of bias independently. BAB reviewed the selected articles and extracted data to ensure information was complete. The risk of bias tool was designed by PSS and modified by MH for studies in the field of nutrition and bone health. All authors commented on and approved the final manuscript. AMC has primary responsibility for final content.

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • M. Hamidi
    • 1
    • 3
  • B. A. Boucher
    • 4
    • 5
    • 6
  • A. M. Cheung
    • 2
    • 3
    • 6
    • 7
    • 8
  • J. Beyene
    • 6
    • 8
    • 9
    • 10
    • 11
    • 12
  • P. S. Shah
    • 6
    • 12
  1. 1.Women’s Health and Osteoporosis ProgramsUniversity Health NetworkTorontoCanada
  2. 2.Women’s Health and Osteoporosis ProgramsUniversity Health NetworkTorontoCanada
  3. 3.Institute of Medical ScienceUniversity of TorontoTorontoCanada
  4. 4.Prevention and Cancer ControlCancer Care OntarioTorontoCanada
  5. 5.Department of Nutritional SciencesUniversity of TorontoTorontoCanada
  6. 6.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  7. 7.Divisions of General Internal Medicine and Endocrinology and Metabolism, Department of MedicineUniversity of TorontoTorontoCanada
  8. 8.Department of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  9. 9.Population Health SciencesResearch Institute of the Hospital for Sick ChildrenTorontoCanada
  10. 10.Program in Population Genomics, Department of Clinical Epidemiology and Biostatistics, Faculty of Health SciencesMcMaster UniversityHamiltonCanada
  11. 11.Department of Pathology and Molecular Medicine, Department of MedicineMcMaster UniversityHamiltonCanada
  12. 12.Department of PaediatricsMount Sinai HospitalTorontoCanada

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