Osteoporosis International

, Volume 29, Issue 7, pp 1591–1599 | Cite as

Mediterranean diet and hip fracture incidence among older adults: the CHANCES project

  • V. BenetouEmail author
  • P. Orfanos
  • D. Feskanich
  • K. Michaëlsson
  • U. Pettersson-Kymmer
  • L. Byberg
  • S. Eriksson
  • F. Grodstein
  • A. Wolk
  • N. Jankovic
  • L. C. P. G. M de Groot
  • P. Boffetta
  • A. Trichopoulou
Original Article



The association between adherence to Mediterranean diet (MD) and hip fracture incidence is not yet established. In a diverse population of elderly, increased adherence to MD was associated with lower hip fracture incidence. Except preventing major chronic diseases, adhering to MD might have additional benefits in lowering hip fracture risk.


Hip fractures constitute a major public health problem among older adults. Latest evidence links adherence to Mediterranean diet (MD) with reduced hip fracture risk, but still more research is needed to elucidate this relationship. The potential association of adherence to MD with hip fracture incidence was explored among older adults.


A total of 140,775 adults (116,176 women, 24,599 men) 60 years and older, from five cohorts from Europe and the USA, were followed-up for 1,896,219 person-years experiencing 5454 hip fractures. Diet was assessed at baseline by validated, cohort-specific, food-frequency questionnaires, and hip fractures were ascertained through patient registers or telephone interviews/questionnaires. Adherence to MD was evaluated by a scoring system on a 10-point scale modified to be applied also to non-Mediterranean populations. In order to evaluate the association between MD and hip fracture incidence, cohort-specific hazard ratios (HR), adjusted for potential confounders, were estimated using Cox proportional-hazards regression and pooled estimates were subsequently derived implementing random-effects meta-analysis.


A two-point increase in the score was associated with a significant 4% decrease in hip fracture risk (pooled adjusted HR 0.96; 95% confidence interval (95% CI) 0.92–0.99, pheterogeneity = 0.446). In categorical analyses, hip fracture risk was lower among men and women with moderate (HR 0.93; 95% CI 0.87–0.99) and high (HR 0.94; 95% CI 0.87–1.01) adherence to the score compared with those with low adherence.


In this large sample of older adults from Europe and the USA, increased adherence to MD was associated with lower hip fracture incidence.


Aging Bone health CHANCES Dietary patterns Hip fractures Mediterranean diet 



This work, derived from the CHANCES project, was supported by the FP7 framework program of DG-RESEARCH in the European Commission (grant number: HEALTH-F3-2010-242244). The national cohorts were supported by: EPIC-Elderly Greece: the Hellenic Health Foundation; EPIC-Elderly Umea, Sweden: the Swedish Cancer Society and the Swedish Research Council; COSM and SMC, Karolinska Institutet, Sweden: the Swedish Research Council Karolinska Institutet’s Strategic Foundation and Uppsala University, and the Swedish Cancer Society; NHS: the National Cancer Institute (grant UM1 CA186107).

Compliance with ethical standards

Conflicts of interest

Francine Grodstein declares unrestricted research gift from California Walnut Commission. Other authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

198_2018_4517_MOESM1_ESM.doc (102 kb)
ESM 1 (DOC 102 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • V. Benetou
    • 1
    Email author
  • P. Orfanos
    • 1
    • 2
  • D. Feskanich
    • 3
  • K. Michaëlsson
    • 4
  • U. Pettersson-Kymmer
    • 5
  • L. Byberg
    • 4
  • S. Eriksson
    • 6
  • F. Grodstein
    • 3
  • A. Wolk
    • 4
    • 7
  • N. Jankovic
    • 8
    • 9
  • L. C. P. G. M de Groot
    • 9
  • P. Boffetta
    • 10
  • A. Trichopoulou
    • 2
  1. 1.WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of MedicineNational and Kapodistrian University of AthensAthensGreece
  2. 2.Hellenic Health FoundationAthensGreece
  3. 3.Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical SchoolBostonUSA
  4. 4.Department of Surgical Sciences, Section of OrthopedicsUppsala UniversityUppsalaSweden
  5. 5.Department of Pharmacology and Clinical Neurosciences and Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
  6. 6.Department of Community MedicineUmeå UniversityUmeåSweden
  7. 7.Institute of Environmental Medicine, Division of Nutritional EpidemiologyKarolinska InstitutetStockholmSweden
  8. 8.Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry, and Epidemiology, Faculty of MedicineUniversity Duisburg-EssenEssenGermany
  9. 9.Division of Human NutritionWageningen UniversityWageningenThe Netherlands
  10. 10.Institute for Translational Epidemiology and Tisch Cancer InstituteIcahn School of Medicine at Mount SinaiNew YorkUSA

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