A 20-year UK study reveals that simple dietary shifts can lower fracture and cardiovascular risks—offering a compelling case for lifestyle change, especially in men.

Study: 60 is the new 40: preparing for better bone health in later life. Image Credit: Umomos / Shutterstock

In a recent study published in the journal Frontiers in Aging, researchers at the University of Southampton, UK, assessed associations between nutritional factors and fracture and cardiovascular mortality outcomes.

Osteoporosis is a chronic condition characterized by reduced bone quality and density, which leads to higher bone fragility and increases susceptibility to fractures. The spine, wrist, and hip are the most common sites for osteoporotic fractures; these fractures represent a public health concern, especially for older adults.

Moreover, the burden of osteoporotic fractures is considerably high and is projected to grow with the aging population. Understanding the risk of osteoporotic fractures in males is particularly challenging. Despite a lifetime risk of up to 25% and the evidence of increased mortality and morbidity among males with hip fractures, bone health awareness is poor in the male community. The study intentionally contrasted fracture outcomes with cardiovascular mortality, as men often perceive heart disease risks more acutely—a strategy to enhance engagement with bone health messaging.

About the Study

In the present study, researchers evaluated associations between fractures and lifestyle. The Hertfordshire Cohort Study participants born from 1931 to 1939 and still living in Hertfordshire between 1998 and 2004 underwent a clinic-based health assessment and completed a home interview. The study also included a nested intervention trial testing “Healthy Conversation Skills” to promote healthier behaviors in older adults, though this was not the focus of the published analysis. During the interview, information on smoking habits, diabetes, hypertension, and physical activity was collected.

The food frequency questionnaire (FFQ) was administered for dietary assessment. Foods were classified into 51 groups according to their nutrient composition and type. Dietary patterns were assessed using the principal component analysis (PCA) of the weekly intake frequencies of the food groups. A prudent dietary pattern was described as a higher intake of vegetables, fruits, oily fish, and whole-grain cereals and a lower intake of chips, white bread, full-fat dairy products, and sugar.

A prudent diet score was calculated; higher scores indicated increased consumption of healthy foods and lower intake of less healthy items. Dietary intake of calcium was evaluated using the FFQ. At the clinic visit, hip and waist circumferences were measured to estimate the waist-to-hip ratio (WHR). An oral glucose tolerance test was performed on those not previously diagnosed with diabetes.

Hypertension was defined as using antihypertensive medication or a mean systolic or diastolic pressure of ≥ 160 or 90 mmHg, respectively. Adverse health outcomes were identified using hospital episode statistics and mortality data. Exposures in relation to adverse health events were examined using Cox regression. Adverse health events included cardiovascular mortality, any fracture, and hip fracture.

Exposures were age, smoking, prudent diet score, high alcohol intake, dietary calcium intake, high WHR, physical activity, diabetes, hypertension, and use of calcium medications/supplements. Additionally, supplementary analyses were performed using linear or logistic regression to examine prudent diet scores in relation to physical activity, high alcohol intake (weak association, p = 0.542), and ever-smoking.

Findings

The study included 1,579 males and 1,418 females, with mean baseline ages of 65.7 and 66.6 years, respectively. Participants were followed up from baseline (1998–2004) to 2018, during which 22% of females and 9% of males had any fracture, 5% of females and 2% of males had a hip fracture, and 5% of females and 11% of males had cardiovascular-related mortality.

Overall, there was borderline evidence (p = 0.052) that a higher diet quality was associated with a lower risk of hip fracture. In contrast, there was no association between dietary calcium intake and any hip fracture. Notably, calcium supplements were not linked to increased cardiovascular risk (a key reassurance given prior concerns), though their use was tied to higher fracture risk, likely due to reverse causality (e.g., supplements being prescribed after a fracture). Increased dietary calcium intake was protective against cardiovascular mortality.

Comorbidities and other lifestyle factors were associated with higher risks of cardiovascular mortality and any fracture. That is, lower physical activity and ever smoking at baseline increased the risk of any fracture; baseline hypertension was associated with a higher hip fracture risk. Further, higher prudent diet scores were associated with higher physical activity and lower odds of ever smoking.

Conclusions

In sum, a more prudent diet was slightly protective against cardiovascular mortality and hip fracture over two decades of follow-up. Higher diet quality was associated with factors positively related to bone health, such as never smoking and higher physical activity. These factors had similar benefits for cardiovascular outcomes. These associations could help tailor public health strategies, particularly for men, by framing bone health improvements within the context of cardiovascular risk reduction—a more familiar and motivating concern for this demographic.

The study’s limitations include its entirely Caucasian cohort, which may limit generalizability to other populations. Additionally, dietary data relied on self-reports rather than blood biomarkers for nutrients like vitamin D.