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Association between total and animal proteins with risk of fracture: A systematic review and dose–response meta-analysis of cohort studies

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Abstract

Previous cohort studies have indicated that consumption of total and animal proteins are related to fracture risk; however, results were inconclusive. This dose-dependent review sought to summarize the earlier evidence regarding the relation between total and animal proteins and fracture risk. We searched Scopus, PubMed, and Web of Science until July 2023 for original research articles examining the association of certain types of proteins and the incidence of all fractures in general adults. Summary relative risks (RRs) were calculated using random effects analysis to examine the relation between each certain amount (g/day) increment of total and animal protein and fracture risk. Twenty cohort studies with serious to moderate risk of bias involving 780,322 individuals were included. There was a non-statistically significant relation between intake of animal proteins and dairy products and all fracture risk. However, 43% and 5% decreased incidence of fracture was obtained with total protein (RR, 0.57; 95%CI, 0.36 to 0.93; per 100 g/day) and fish (RR, 0.95; 95%CI, 0.91 to 0.99; per 15 g/day) intake. Every 100 g/day total and animal protein consumption and every 15 g/day fish consumption were linked to 48%, 50%, and 5% lower hip fracture risk. Greater dietary animal protein intake might reduce risk of hip but not fracture at any site. We obtained a lower risk of any or hip fracture with greater total protein (per 100 g/day) and fish (per 15 g/day) intake. No evidence was obtained that higher intake of dairy could decrease risk of fracture.

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Data availability

All data indicated and analyzed for this study are available by request to the corresponding author.

Abbreviations

BMI:

Body mass index

BMD:

Bone mineral density

CI:

Confidence intervals

HR:

Hazard ratio

GRADE:

Grading of Recommendations, Assessment, Development, and Evaluations

IGF-1:

Insulin-like growth factor-1

OR:

Odds ratio

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RR:

Relative risk

ROBINS-I:

Risk Of Bias In Non-randomized Studies-of Interventions

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Authors and Affiliations

  1. Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran

    Sheida Zeraattalab-Motlagh & Akram Sadat Mortazavi

  2. Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran

    Seyed Mojtaba Ghoreishy

  3. Student Research Committee, School of Public Health, Iran University of Medical Sciences, Tehran, Iran

    Seyed Mojtaba Ghoreishy

  4. Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran

    Hamed Mohammadi

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  1. Sheida Zeraattalab-Motlagh
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Zeraattalab-Motlagh, S., Mortazavi, A.S., Ghoreishy, S.M. et al. Association between total and animal proteins with risk of fracture: A systematic review and dose–response meta-analysis of cohort studies. Osteoporos Int 35, 11–23 (2024). https://doi.org/10.1007/s00198-023-06948-8

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