Osteoporosis International

, Volume 24, Issue 5, pp 1587–1598 | Cite as

Mediterranean diet and incidence of hip fractures in a European cohort

  • V. BenetouEmail author
  • P. Orfanos
  • U. Pettersson-Kymmer
  • U. Bergström
  • O. Svensson
  • I. Johansson
  • F. Berrino
  • R. Tumino
  • K. B. Borch
  • E. Lund
  • P. H. M. Peeters
  • V. Grote
  • K. Li
  • J. M. Altzibar
  • T. Key
  • H. Boeing
  • A. von Ruesten
  • T. Norat
  • P. A. Wark
  • E. Riboli
  • A. Trichopoulou
Original Article



Prevention of hip fractures is of critical public health importance. In a cohort of adults from eight European countries, evidence was found that increased adherence to Mediterranean diet, measured by a 10-unit dietary score, is associated with reduced hip fracture incidence, particularly among men.


Evidence on the role of dietary patterns on hip fracture incidence is scarce. We explored the association of adherence to Mediterranean diet (MD) with hip fracture incidence in a cohort from eight European countries.


A total of 188,795 eligible participants (48,814 men and 139,981 women) in the European Prospective Investigation into Cancer and nutrition study with mean age 48.6 years (±10.8) were followed for a median of 9 years, and 802 incident hip fractures were recorded. Diet was assessed at baseline through validated dietary instruments. Adherence to MD was evaluated by a MD score (MDs), on a 10-point scale, in which monounsaturated were substituted with unsaturated lipids. Association with hip fracture incidence was assessed through Cox regression with adjustment for potential confounders.


Increased adherence to MD was associated with a 7 % decrease in hip fracture incidence [hazard ratio (HR) per 1-unit increase in the MDs 0.93; 95 % confidence interval (95 % CI) = 0.89–0.98]. This association was more evident among men and somewhat stronger among older individuals. Using increments close to one standard deviation of daily intake, in the overall sample, high vegetable (HR = 0.86; 95 % CI = 0.79–0.94) and high fruit (HR = 0.89; 95 % CI = 0.82–0.97) intake was associated with decreased hip fracture incidence, whereas high meat intake (HR = 1.18; 95 % CI = 1.06–1.31) with increased incidence. Excessive ethanol consumption (HR high versus moderate = 1.74; 95 % CI = 1.32–2.31) was also a risk factor.


In a prospective study of adults, increased adherence to MD appears to protect against hip fracture occurrence, particularly among men.


A priori methods Bone health Diet Dietary patterns Hip fractures Mediterranean diet 



The EPIC study was funded by “Europe Against Cancer” Programme of the European Commission (SANCO), German Cancer Aid, German Cancer Research Center (DKFZ), German Federal Ministry of Education and Research, Greek Ministry of Health, Hellenic Health Foundation, Stavros Niarchos Foundation, Italian Association for Research on Cancer, Italian National Research Council, Dutch Prevention Funds, LK Research Funds, Dutch ZON (Zorg Onderzoek Nederland), The CIBER en Epidemiología y Salud Pública (CIBERESP), Research Institute Biodonostia, Basque Regional Government, World Cancer Research Fund (WCRF), Cancer Research UK, the Swedish Research Council, Medical Faculty of Umeå University, and the county council of Västerbotten. We also thank Göran Hallmans, Åsa Ågren, Hubert Sjödin, and Magnus Hellström for skillful data processing and for help creating the Swedish fracture database, and participants and staff from the NSHDS cohort study.

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • V. Benetou
    • 1
    • 16
    Email author
  • P. Orfanos
    • 1
  • U. Pettersson-Kymmer
    • 2
  • U. Bergström
    • 3
  • O. Svensson
    • 3
  • I. Johansson
    • 4
  • F. Berrino
    • 5
  • R. Tumino
    • 6
  • K. B. Borch
    • 7
  • E. Lund
    • 7
  • P. H. M. Peeters
    • 8
    • 9
  • V. Grote
    • 10
  • K. Li
    • 10
  • J. M. Altzibar
    • 11
  • T. Key
    • 12
  • H. Boeing
    • 13
  • A. von Ruesten
    • 13
  • T. Norat
    • 9
  • P. A. Wark
    • 9
  • E. Riboli
    • 14
  • A. Trichopoulou
    • 1
    • 15
  1. 1.WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical StatisticsUniversity of Athens Medical SchoolAthensGreece
  2. 2.Department of Pharmacology and Clinical NeurosciencesUmeå UniversityUmeåSweden
  3. 3.Department of Surgical and Perioperative SciencesUmeå UniversityUmeåSweden
  4. 4.Department of OdontologyUmeå UniversityUmeåSweden
  5. 5.Department of Preventive and Predictive Medicine, Epidemiology UnitFondazione IRCCS Instituto Nazionale TumoriMilanItaly
  6. 6.Cancer Registry and Histopathology Unit“Civile M.P.Arezzo” HospitalRagusaItaly
  7. 7.Department of Community MedicineUniversity of TromsøTromsøNorway
  8. 8.Julius CenterUniversity Medical Center UtrechtUtrechtThe Netherlands
  9. 9.Department of Epidemiology and Biostatistics, School of Public Health, Faculty of MedicineImperial College, St. Mary’s CampusLondonUK
  10. 10.Division of Cancer Epidemiology c020German Cancer Research Center (DKFZ)HeidelbergGermany
  11. 11.Public Health Division of Gipuzkoa, Health Department of Basque Country, BIODonostia Research InstituteCIBER Epidemiología y Salud Pública CIBERESPSan SebastianSpain
  12. 12.Cancer Epidemiology UnitUniversity of OxfordOxfordUK
  13. 13.Department of EpidemiologyGerman Institute of Human Nutrition Potsdam-RehbrueckeNuthetalGermany
  14. 14.School of Public HealthImperial CollegeLondonUK
  15. 15.Hellenic Health FoundationAthensGreece
  16. 16.Department of Hygiene, Epidemiology and Medical StatisticsUniversity of Athens Medical SchoolAthensGreece

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