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Evaluating and Strengthening the Evidence for Nutritional Bone Research: Ready to Break New Ground?


J Bone Miner Res. 2021 Feb;36(2):219-226. doi: 10.1002/jbmr.4236. Epub 2021 Jan 27.

Joshua R Lewis 1 2 3Trudy Voortman 4John Pa Ioannidis 5 6 7 8 9

Author Information

1 Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.

2 Medical School, The University of Western Australia, Perth, WA, Australia.

3 Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.

4 Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.

5 Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA, USA.

6 Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA.

7 Department of Biomedical Data Science, Stanford University, Stanford, CA, USA.

8 Department of Statistics, Stanford University, Stanford, CA, USA.

9 Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.


A healthy diet is essential to attain genetically determined peak bone mass and maintain optimal skeletal health across the adult lifespan. Despite the importance of nutrition for bone health, many of the nutritional requirements of the skeleton across the lifespan remain underexplored, poorly understood, or controversial. With increasingly aging populations, combined with rapidly changing diets and lifestyles globally, one anticipates large increases in the prevalence of osteoporosis and incidence of osteoporotic fractures. Robust, transparent, and reproducible nutrition research is a cornerstone for developing reliable public health recommendations to prevent osteoporosis and osteoporotic fractures. However, nutrition research is often criticized or ignored by healthcare professionals due to the overemphasis of weak science, conflicting, confusing or implausible findings, industry interests, common misconceptions, and strong opinions. Conversely, spurious research findings are often overemphasized or misconstrued by the media or prominent figures especially via social media, potentially leading to confusion and a lack of trust by the general public. Recently, reforms of the broader discipline of nutrition science have been suggested and promoted, leading to new tools and recommendations to attempt to address these issues. In this perspective, we provide a brief overview of what has been achieved in the field on nutrition and bone health, focusing on osteoporosis and osteoporotic fractures. We discuss what we view as some of the challenges, including inherent difficulties in assessing diet and its change, disentangling complex interactions between dietary components and between diet and other factors, selection of bone-related outcomes for nutrition studies, obtaining evidence with more unbiased designs, and perhaps most importantly, ensuring the trust of the public and healthcare professionals. This perspective also provides specific recommendations and highlights new developments and future opportunities for scientists studying nutrition and bone health. © 2021 American Society for Bone and Mineral Research (ASBMR).