A Mediterranean diet can significantly lower the risk of overall fractures, according to a major new review from the University of Chester.

Researchers from the university's medical school have closely analysed 30 studies involving more than 500,000 adults to provide new insights into how popular diets affect bone health.

Dietary patterns play a crucial role in musculoskeletal health.

However, with no integrated examination across dietary patterns, previous research has focused on the effects of diets in a specific population on factors such as bone mineral density (BMD), fracture risk, and bone metabolism.

This systematic review sought to determine trends and evaluate the impact of Mediterranean, calorie restriction, high-protein, low-carbohydrate, and ketogenic diets on skeletal health in adults. 

Ketogenic diets are characterised by markedly reduced carbohydrates, accompanied by a moderate to high consumption of dietary fats.

The results, recently published in Nutrients, reveal that whilst dietary patterns showed no major impact on Bone Mineral Density (BMD) itself, adherence to a Mediterranean diet significantly lowered the risk of hip and overall fractures.

In contrast, calorie restriction was consistently associated with increased markers of bone breakdown. High-protein and low-carbohydrate diets had mixed or neutral effects.

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The new study was led by associate professor Dr Ioannis Kanakis from Chester Medical School (CMS) and former CMS Lecturer, Dr Ioanna Myrtziou. The research work was conducted by past and current postgraduate students, Adhithya Mullath Ullas, Joseph Boamah and Amir Hussain. 

"Musculoskeletal diseases represent a significant and growing public health concern worldwide, contributing to decreased mobility, disability, and reduced quality of life among ageing populations," said Dr Kanakis.

"Conditions such as osteoporosis, fragility fractures, and falls are closely interrelated - often coexisting and compounding the risk for health. 

"While pharmacological treatments remain central to the management of musculoskeletal pain, growing attention has turned to complementary and non-pharmacological strategies - such as lifestyle interventions, particularly diet, as modifiable factors influencing bone, muscle, and joint health.

"This comprehensive evaluation of dietary patterns is therefore needed, and to our knowledge, this is the first systematic review which collectively analyses the impact of these specific diets on bone homeostasis - the continuous renewal of bone tissue - with a high number of participants." 

The study outlines how nutrition plays a pivotal role in skeletal health by acting through multiple pathways that extend beyond the provision of isolated nutrients.

While calcium, vitamin D, and protein are fundamental to bone health and maintenance, it explains that dietary patterns overall influence musculoskeletal outcomes by integrating a broad spectrum of bioactive compounds, micronutrients, and macronutrient interactions. 

Dr Kanakis continued: "Plausible reasons for the findings on the Mediterranean diet include higher intakes of fruits, vegetables, whole grains, legumes, fish, and olive oil that collectively supply calcium, magnesium, vitamin K, potassium, polyphenols (natural compounds found in plants), and anti-inflammatory constituents supportive of bone remodelling and microarchitecture. 

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"Conversely, diets that heavily restrict energy, as in calorie restriction, or omit major food groups, can reduce mechanical loading via weight loss, alter drivers of bone remodelling and change calcium or vitamin D biological availability, thereby increasing resorption - the breakdown of bone tissue."

He concluded: "This work clarifies the complex relationship between nutrition and musculoskeletal health, reinforcing the Mediterranean diet as a practical dietary strategy to reduce fracture risk and informing guidelines for managing bone health during weight loss."

You can read the paper here.