Effects of high-risk fat dietary pattern on bone mineral density and osteoporosis risk: a prospective cohort study

Osteoporosis is a growing public health burden with dietary nutrients serving as key determinants influencing bone mineral density (BMD). This study examined the associations of single nutrients and high-risk fat dietary patterns with BMD and osteoporosis risk. We included 73,945 participants from the UK Biobank who completed at least one Oxford WebQ 24-hour dietary questionnaire. Single dietary nutrients were categorized into quartiles (Q1–Q4). High-risk fat dietary patterns were derived using two complementary approaches: reduced rank regression (RRR) and diet quality score. Generalized linear models were applied to examine the associations between dietary nutrients and high-risk fat dietary patterns with BMD. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations with incident osteoporosis. Our study identified 11 nutrients associated with BMD, including intrinsic and milk sugars (β Q4vsQ1 = 0.008, P_adjust = 0.024), and manganese (β Q4vsQ1 = 0.007, P_adjust = 0.03). Three fat-related nutrients were negatively associated with osteoporosis risk. For example, the HRs of saturated fatty acids from the lowest to highest quintiles were 1 (reference), 1.27 ( P_adjust = 0.189), 1.34 ( P_adjust = 0.112), and 1.40 ( P_adjust = 0.046 ) . Greater adherence to the score-based high-risk dietary fat pattern was associated with lower BMD (β Q4vsQ1 =-0.008, P < 0.001) and higher osteoporosis risk (β Q4vsQ1 = 1.34, P = 0.002). Conversely, greater adherence to the RRR-derived dietary pattern were significantly associated with BMD (β Q4vsQ1 = 0.006, P = 0.008) but showed no significant association with osteoporosis risk ( P > 0.05). Our findings suggest that specific dietary nutrients and greater adherence to high-risk fat dietary patterns are associated with lower BMD and higher osteoporosis risk.