Pro-inflammatory diet during pre-, early perimenopause raises fracture risk

Key Takeaways:

• Each 1 SD increase in pro-inflammatory diet index score in pre- and early perimenopause increased fracture risk by up to 28%.
• Future studies should explore the mechanisms of the association.

Women who maintained a more pro-inflammatory diet before menopause and in early perimenopause had increased risk for future fractures, according to data from the Study of Women’s Health Across the Nation.

“At the present time, whether a more inflammatory dietary pattern is associated with greater fracture risk is uncertain: Results from several studies of mostly older adults are inconsistent,” Albert Shieh, MD, endocrinologist in the department of medicine at the David Geffen School of Medicine at UCLA, and colleagues wrote. “Moreover, to our knowledge, there have been no investigations of the potential relation between an inflammatory dietary profile and incident fractures starting early in the menopause transition and continuing into post-menopause, specifically.”

Researchers quantified dietary inflammatory potential using two energy-adjusted dietary inflammatory index scores — one for diet only and one for diet plus supplements. Researchers included 1,559 women (mean age, 45 years; mean BMI, 27 kg/m²; 42% white, 26% Black, 15% Chinese, 17% Japanese) from the Study of Women’s Health Across the Nation (SWAN) with scores from both indexes from baseline to up to 20 years of follow-up. Participants did not take bone-beneficial or bone-detrimental medications, aspirin or NSAIDs at baseline and had one or more follow-up visit.

Overall, 175 women sustained an incident fracture with an average time to first fracture of 7.8 years. The most common fracture sites were foot, ankle, arm, wrist and leg; three women had vertebral fractures and two had hip fractures.

After adjusting for age, BMI, smoking status, diabetes, menopause transition stage, race/ethnicity, prior fracture, bone-detrimental medication use, aspirin or NSAID use and study site, greater index scores for diet only and diet plus supplements were associated with more fractures. For every standard deviation increment in index scores for diet only and diet plus supplements, researchers noted a predicted 28% (P = .005) and 21% (P = .02) greater risk for fracture.

These associations remained unchanged after controlling for bone mineral density and for calcium intake, physical activity, education level and family-adjusted poverty-to-income ratio.

According to the researchers, identifying risk factors for appendicular fractures occurring when women are aged 50 to 70 years is important because it can directly lead to morbidity and double the risk for hip fractures in older age.

“Future studies should investigate the mechanisms by which pro-inflammatory diets contribute to fracture, including the relation between dietary inflammation and change in body composition over time,” the researchers wrote.