. 2017 Sep 18;9(9):1029. doi: 10.3390/nu9091029

Table 1.

Study characteristics.

References	Number of Participants	Age (Years)	Country	Duration of the Study	Dietary Patterns Association with Osteoporosis Outcome Results		Conclusions	Summary of Effect on BMD	Study Design (Level of Evidence)
References	Number of Participants	Age (Years)	Country	Duration of the Study	Meat	Fish	Conclusions	Summary of Effect on BMD	Study Design (Level of Evidence)
Langsetmo, L. et al. (2011) [21]	5188 subjects (1649 men; 3539 women)	≥50	Canada	2 years	Energy-dense factor (EDF) (representing energy-dense foods such as processed meat) are associated with HRs for risk of fractures of: 1.01 (p = NS) in women and of 1.08 (p = NS) in men.	NR	The intake of processed meat was not associated with fractures.	Meat: no effect on BMD; Fish: NR.	Retrospective cohort study
Karamati, M. et al. (2014) [22]	151 women	60.3 (59.1–61.6)	Iran	3 years	NR	Pattern 2: includes fish intake. Pairwise difference between Lumbar spine: −0.01 g/cm² (p = NS); Femoral neck: 0.01 g/cm² (p = NS).	Pattern 2: (fish intake) was not associated with lumbar spine or femoral neck BMD.	Meat: NR; Fish: no effect on BMD.	Cross-sectional study
Langsetmo, L. et al. (2010) [23]	6539 subjects (1928 men; 4611 women)	Men: 58.8 (±13.5) women: 61.2 (±12.2)	Canada	5 years (secondary outcome); 2 years (primary outcome)	Energy dense food (included meat). R² for dietary patterns and energy intake as predictors of femoral neck BMD (g/cm²). The parameter estimates are for each 1 SD increase of the nutrient dense factor score, the energy dense factor score, the difference between energy dense and nutrient dense factor score, and the log-transformed energy intake (1 SD is roughly 36% change in energy intake). p-Values for null hypothesis (from top to bottom). Adult Men: p = NS. Older Men: p = 0.007 (decrease 1 SD with meat). Premenopausal Women: p = NS. Postmenopausal Women: p = 0.032 (decrease 1 SD with meat).	Nutrient dense score food (included fish). R² for dietary patterns and energy intake as predictors of femoral neck BMD (g/cm²). The parameter estimates are for each 1 SD increase of the nutrient dense factor score, the energy dense factor score, the difference between energy dense and nutrient dense factor score, and the log-transformed energy intake (1 SD is roughly 36% change in energy intake). p-values for null hypothesis (from top to bottom). Younger Men: p = 0.028 (increase 1 SD with fish); Older men: p = NS. Premenopausal Women: p = NS. Postmenopausal Women: p = NS.	Fish increased BMD in younger men. In older men Meat decreased BMD in older men and in postmenopausal women.	Meat: decreased BMD; Fish: increased BMD.	Longitudinal cohort study
Wosje K. et al. (2010) [24]	325 children	3.8–7.8	USA	4 years	Pattern 1: (meat, poultry, processed meat) high intake of meat. Bone mass increase during the quartile in 1,3 and 4 year (p < 0.01).	Pattern 2: high intake of fish. Bone mass increase during the quartile in year 1 and 3 (p < 0.01) and decrease during the quartile 4.	Pattern 1 (meat) was significantly associated with higher bone mass. Pattern 2 (fish) data related to bone mass were contradictory	Meat: increased BMD; Fish: no effect on BMD.	Longitudinal study
Fairweather-Tait S.J. et al. (2011) [25]	2464 women	56.3 (±11.9)	UK	11 years	Traditional English pattern score (high intake of fish): Spine: BMD ∆: −0.035 g/cm² (p < 0.05); Total hip: BMD ∆: −0.039 g/cm² (p < 0.01); Hip Neck: BMD ∆: −0.055 g/cm² (p < 0.01).		High intakes of fried fish, fried potatoes, legumes (e.g., baked beans), red and processed meat, vegetables was associated with a lower BMD.	Meat: decreased BMD; Fish: decreased BMD.	Co-twin control study
Shin S. et al. (2013) [26]	3735 women	64.1 (±9.5)	South Korea	3 years	Factor 1: meat consumption. CC among Factor 1 and BMD: Total femur: 0.005 CC; Trochanter: 0.008 CC; Intertrochanter: 0.004 CC; Femoral neck: 0.003 CC; Ward: 0.005 CC; Lumbar spine: 0.031 CC; (p = NS) Risk for osteoporosis of the femoral neck and lumbar spine across the quintile (Q) categories in factor 1: Femoral neck odds ratio (OR): 1.01 (p = NS); Lumbar spine: OR: 0.72 (p = NS).	Factor 3: Seaweed consumption. Correlation coefficients (CC) among Factor 3 and bone mineral density (BMD): Total femur 0.006 CC; Trochanter 0.011 CC; Intertrochanter −0.009 CC; Femoral neck −0.014 CC; Ward −0.040 CC; Lumbar spine −0.040 CC; Risk for osteoporosis of the femoral neck and lumbar spine across the quintile (Q) categories in factor 3: Femoral neck odds ratio (OR): 0.70 (p = NS); Lumbar spine: OR: 0.94 (p = NS).	Seaweed pattern (Factor 3) had a 40% higher risk of osteoporosis in the lumbar spine.	Meat: no effect on BMD; Fish: decreased BMD.	The Korea National Health and Nutrition Examination Survey (KNHANES: nationwide cross-sectional survey)
Shin S. et al. (2015) [27]	1818 subjects (716 men; 1102 women)	46.4 (±12.3)	South Korea	2 years and 6 month	Factor 2: meat consumption (Meat/poultry/processed meats). Correlation coefficients (CC) among Factor 2 and BMD: Whole arm (g/cm²) −0.048 * CC; Whole leg (g/cm²): −0.041 CC; Whole pelvis (g/cm²): −0.020 CC; Whole spine (g/cm²): −0.023 CC; Whole body (g/cm²): 0.035 * CC.	Factor 1: fish Consumption. CC among Factor 1 and BMD: Whole arm (g/cm²) 0.088 *** CC; Whole leg (g/cm²) 0.050 * CC; Whole pelvis (g/cm²): 0.038 CC; Whole spine (g/cm²): 0.045 CC; Whole body (g/cm²): 0.017 CC.	The dietary pattern characterized by the consumption of fish and shellfish was significantly associated with whole-arm BMD only and not with other BMD measurements.	Meat: decreased BMD; Fish: increased BMD.	Healthy Twins Cohort, cross-sectional survey
Park S.J. e al. (2012) [28]	1464 women	58.8 (±6.7)	South Korea	4 years	Factor 3 (Western diet): meat consumption: Radius RR (Risk Ratio): 1.46 (p < 0.05) Tibia RR: 1.46 (p = NS)	Factor 1 (Traditional diet): fish and seaweed consumption: Radius RR (Risk Ratio): 1.46 (p < 0.05); Tibia RR: 1.82 (p < 0.05).	Traditional diet with high intake of fish and Western with high intake of meat dietary patterns were associated with greater risk for osteoporosis in postmenopausal Korean women.	Meat: decreases BMD; Fish: decreases BMD.	The Korean Genome and Epidemiology Study (KoGES) is a longitudinal cohort study
Go G. et al. (2014) [29]	847 women	NR	South Korea	1 year	Food group with intake of meat (excluding dairy products, and including grain, vegetables and fruits): GMdVF (Grain, Meat, Dairy, Vegetable, Fruit Capital letter indicates eating a certain amount from the food group; lower case letter means not eating a certain amount from the food group): Normal (n = 136): GMdVF: 73 (53.7% n. of subject); Osteopenia (n = 413): GMdVF: 216 (53.0%); Osteoporosis (n = 298): GMdVF: 166 (59.5%).	NR	Meat consumption does not increase BMD. High number of subjects in group of osteoporosis versus normal (59% vs. 53.7%)	Meat: decreases BMD; Fish: NR.	The Korea National Health and Nutrition Examination Survey (KNHANES: nationwide cross-sectional survey)
Chan R. et al. (2015) [30]	2724 women	71.8 (±4.8)	Hong Kong	2 years	Factor 3: (Meat-Fish) OR: 0.86 (IC 95%: 0.59–1.24) (p = NS)	Factor 3: (Fish-meat) OR: 0.86 (IC 95%: 0.59–1.24) (p = NS)	There was no association of “meat-fish” pattern with incident frailty	Meat: no effect on BMD; Fish: no effect on BMD.	Prospective cohort study
Choi E. et al. (2016) [31]	9812 women	60	South Korea United States	3 years	NR	In NHANES: p = NS; In KNHANES: p < 0.05; Correlation coefficients (CC) between bone mineral density (g/cm²) of: Total femur (g/cm²) men: 0.0748 CC; women: 0.1611 CC; Femoral neck (g/cm²) men: 0.0768 CC; women: 0.1806 CC; Lumbar spine (g/cm²) men: 0.0465 CC; women: 0.1630 CC.	A positive association between the consumption of fish and shellfish and bone health among men and postmenopausal women over 50 years old in Koreans but not in Americans	Meat: NR; Fish: increases BMD.	KNHANES and the NHANES
De Franca N.A.G. et al. (2016) [32]	156 women	68.4 (±9)	Brazil	3 years	Meat included in “Red meat and refined cereals” dietary pattern Factor-loading matrix in red meat pattern for meat; 0.666 score Results of adjusted linear regression analysis (β-coefficient), and 95% confidence interval (95% CI) of the dietary patterns (score values) and body mineral density (g/cm²)): Lumbar spine (β:−0.094) (95% CI: −0.031 to 0.010) Femoral neck (β: −0.005) (95% CI IC: −0.016 to 0.015) Total femur (β:0.038) (95% CI: −0.014 to 0.022) Total body ( β:−0.019) (95% CI: −0.023 to 0.018) (p = NS)	Fish included in “Red meat and refined cereals” dietary pattern. Factor-loading matrix in red meat pattern for fish: −0.472 score. Results of adjusted linear regression analysis (β-coefficient), and 95% confidence interval of the dietary patterns (score values) and body mineral density (g/cm²): Lumbar spine (β:−0.094) (95% CI: −0.031 to 0.010); Femoral neck (β:−0.005) (95% CI: −0.016 to 0.015); Total femur (β: 0.038) (95% CI: −0.014 to 0.022); Total body (β:−0.019) (95% CI: −0.023 to 0.018); (p = NS)	No effects on BMD were observed with meat and fish consumption.	Meat: no effect on BMD; Fish: no effect on BMD.	Cross-sectional study
Nieves J.W. et al. (2010) [33]	125 women	22.1 (±2.6)	USA	2 years	Dietary Pattern 3 (high animal proteins, high fat, low fruit and vegetables, low fiber): Dietary Pattern 3 HR:1.06 (95% CI: 0.54–2.09) (p = NS) Dietary Pattern 4 (high protein) are associated with HR of risk of fractures of: Dietary Pattern 4 HR:1.54 (95% CI: 0.31–7.48) (p = NS) Animal protein (SD) g/day/kg body Weight and Whole-body BMD (g/cm²/year ± SE) 0.00602 ± 0.00219 (p < 0.01)		Protein intake, specifically animal protein, was related to small but significantly greater increases in total body bone mass.	Meat: increases BMD Fish: increases BMD	Prospective cohort study
McNaughton S.A. et al. (2011) [34]	527 women	18–65	Australia	10 years	Pattern 1 (Sausages and processed meat), Factor loading: 0.33 score BMC (g/cm²) β: −15.07 (p < 0.05) Hip BMD (g/cm²) β: 0.0013 (p = NS) Lumbar spine BMD (g/cm²) β:−0.0017 (p = NS) Pattern 2 (red meat), Factor loading: 0.27 score BMC (g/cm²) β: 3.14 (p = NS) Hip BMD (g/cm²) β: −0.0009 (p = NS) Lumbar spine BMD (g/cm²) β: −0.0017 (p = NS)	Pattern 3 (Fish) Factor loading: 0.23 score; BMC (g/cm²) β: 4.60 (p = NS); Hip BMD β: −0.0006 (p = NS); Lumbar spine BMD (g/cm²) β: −0.0001 (p = NS); Pattern 4 (Seafood) Factor loading: 0.48 score; BMC (g/cm²) β: 15.20 (p = NS); Hip BMD (g/cm²) β: 0.0022 (p < 0.05); Lumbar spine BMD (g/cm²) β: 0.0037 (p < 0.05).	Pattern 1(Sausages and processed meat) was inversely associated with total body BMC. Pattern 4 (Seafood) was directly associated with regional BMD and total BMC	Meat: decreases BMD Fish: increases BMD	Cross-sectional study
Monjardino T. et al. (2014) [35]	1023 subjects (474 boys; 549 girls)	13–17	Portugal	2 years	MD (Mediterranean diet) pattern: Meat Girls annual BMD variation (mg/cm² per year): 0.028 (p = NS) Boys annual BMD variation (mg/cm² per year): −0.012 (p = NS) DASH diet (Dietary Approaches to Stop Hypertension) Girls annual BMD variation (mg/cm² per year): −0.002 (p = NS) Boys annual BMD variation (mg/cm² per year): −0.026 (p = NS)	MD pattern: Fish; Girls annual BMD variation (mg/cm² per year): 0.028 (p = NS); Boys annual BMD variation (mg/cm² per year): −0.012 (p = NS); DASH diet (Dietary Approaches to Stop Hypertension): Girls annual BMD variation (mg/cm² per year): −0.002 (p = NS); Boys annual BMD variation (mg/cm² per year): −0.026 (p = NS).	The selected dietary patterns may not capture the elements of diet that are truly important in determining adolescent bone quality	Meat: no effect on BMD; Fish: no effect on BMD	Epidemiological Health Investigation of Teenagers in Porto (EPITeen population based cohort)
Monjardino T. et al. (2015) [36]	1007 subjects (543 girls; 464 boys)	13–17	Portugal	2 years	Lower intake (red meat): Girls annual BMD variation (mg/cm² per year): −0.381 (p = NS); Boys annual BMD variation (mg/cm² per year): 0.333 (p = NS)	Lower intake (fish): Girls annual BMD variation (mg/cm² per year): −0.381 (p = NS); Boys annual BMD variation (mg/cm² per year): 0.333 (p = NS).	There were no consistent associations between dietary patterns and forearm BMD in adolescents.	Meat: no effect on BMD; Fish: no effect on BMD.	Epidemiological Health Investigation of Teenagers in Porto (EPITeen population based cohort)
Zeng F.F. et al. (2013) [37]	581 subjects (148 men; 433 women)	71 (±7)	China	3 years	Healthy Dietary Pattern (Poultry): OR of Hip Fractures (g/cm²) for Tertiles: (T3 vs. T1) OR: 0.42 (95% CI: 0.24-0.73), (p < 0.01) Prudent Dietary Pattern (Red meat): OR of Hip Fractures (g/cm²) for Tertiles: (T3 vs. T1) OR: 0.51 (95% CI: 0.28–0.90),(p < 0.05) Traditional Dietary Pattern (Processed meat, animal organ meat): OR of Hip Fractures (g/cm²) for Tertiles: (T3 vs. T1) OR: 0.83 (95% CI: 0.49–1.43), (p = NS); High Fat Dietary Pattern (Red meat, Poultry, Animal organ meat): OR of Hip Fractures (g/cm²) for Tertiles: (T3 vs. T1) OR: 2.25 (95% CI: 1.38–3.69), (p < 0.01)	Healthy Dietary Pattern (Freshwater fish): OR (Odds Ratio) of Hip Fractures (g/cm²) for Tertiles: (T3 vs. T1) OR: 0.42 (95% CI: 0.24–0.73) (p < 0.01); Prudent Dietary Pattern (shellfish, sea fish, processed fish): OR of Hip Fractures (g/cm²) for Tertiles: (T3 vs. T1) OR: 0.51 (95% CI: 0.28–0.90) (p < 0.05); Traditional Dietary Pattern (shellfish, processed fish): OR of Hip Fractures (g/cm²) for Tertiles: (T3 vs. T1) OR: 0.83 (95% CI: 0.49–1.43) (p = NS); High Fat Dietary Pattern (shellfish) OR of Hip Fractures (g/cm²) for Tertiles: (T3 vs. T1) OR: 2.25 (95% CI: 1.38–3.69) (p < 0.01)	The findings suggest that dietary patterns that feature a high intake of fish and low-fat poultry and a low intake of saturated fat may protect against hip fracture.	Meat: increases BMD Fish: increases BMD	1:1 matched case-control study
Petersen S.B. et al. (2015) [38]	53,922 children	<16	Denmark	6 years	Western (meat): HRs:1.03 (p = NS) Traditional (meat–poultry): HRs: 1.00 (p = NS).	Seafood (fish–shellfish): HRs: 0.94 (p = NS).	There were indications that maternal Western diet was associated with offspring forearm fractures. However, it was not possible to identify any single food item in the Western pattern that appeared to be of importance for offspring forearm fracture risk.	Meat: no effect on BMD Fish: no effect on BMD	Prospective study (Danish National Birth Cohort (DNBC))
van den Hooven E.H. et al. (2015) [39]	1024 young adults	14–20	Australia	2 years	Pattern 2 (high-protein, low-calcium, low-potassium): Factor loading: Meat 0.24; Poultry 0.36; Red meat 0.42; Processed meat 0.29 BMD (mg/cm²): −0.2 (p = NS); BCM (g): −0.5 (p = NS).	Pattern 1 (high-protein, high-calcium, high-potassium) Factor loading: Fish 0.18; BMD (mg/cm²): 8.6 (p < 0.05); BCM (g): 21.9 (p < 0.05).	A dietary pattern characterized by high intake of protein and low intakes of calcium and potassium was not associated with later bone outcomes. A dietary pattern characterized by high-protein, high-calcium, high-potassium was associated with higher BMD and BMC	Meat: no effect on BMD Fish: increases BMD	Longitudinal study based on Western Australian Pregnancy Cohort (Raine) Study
Silva T.R. et al. (2015) [40]	99 women	55.2 (±4.9)	Brazil	2 years	OR for low bone mass: Meat and eggs (<96 g/day): OR 2.30 (p = NS).	NR	Meat intake did not interfere with BMD, but participants were mostly sedentary	Meat: no effect on BMD Fish: NR	Cross-sectional study
Haring B. et al. (2016) [41]	796 women	63.6 (±7.4)	USA	5 years	Mediterranean Diet (aMED) (red and processed meats): HRs: 0.80 (p = NS); Dietary Approaches to Stop Hypertension (DASH) (Red and processed meat): HRs: 0.89 (p = NS).	aMED (Fish) Hazard ratios (HRs): 0.80 (p = NS) Healthy Eating Index 2010 (HEI-2010) (seafood) HRs: 0.87 (p = NS) Alternate Healthy Eating Index 2010 (AHEI-2010) (long-chain ω-3 polyunsaturated fatty acids, polyunsaturated fatty acids) Hazard ratios (HRs): 0.94 (p = NS)	There were no consistent associations between dietary patterns and BMD.	Meat: no effect on BMD; Fish: no effect on BMD.	Women’s Health Initiative observational study (WHI-OS)
Denova-Gutiérrez E. (2016) [42]	6915 subjects (1948 men; 4967 women)	20–80	Mexico	NR	Westernized dietary pattern (red meat): Odds ratios (OR): Total BMD (g/cm²): Q2 1.54; Q5 1.74 (p < 0.05); Hip BMD (g/cm²): Q2 1.40; Q5 1.91 (p < 0.01); Spine BMD (g/cm²): Q2 1.47; Q5 1.61(p < 0.05).	“Dairy and fish” dietary pattern (Fish and sea food) Odds ratios (OR) Total BMD (g/cm²): Q2 0.69; Q5 0.51 (p < 0.001) Hip BMD (g/cm²): Q2 0.99; Q5 0.86 (p = NS) Spine BMD (g/cm²): Q2 0.87; Q5 0.69 (p < 0.001)	A “dairy and fish” dietary pattern may contribute to better BMD. In contrast, a Westernized dietary pattern was significantly associated with higher likelihood of low BMD.	Meat: decreases BMD Fish: increases BMD	Cross-sectional analysis (Health Workers Cohort Study (HWCS))
De Jonge E.A.L. et al. (2016) [43]	5144 men and women	≥55	Netherlands	11 years	Traditional dietary pattern (meat): BMD of the femoral neck: 0.01 g/cm² (p = NS); Processed dietary pattern (processed meat): BMD of the femoral neck: −0.03 g/cm² (p = NS); Health dietary pattern (poultry): BMD of the femoral neck: 0.04 g/cm² (p = 0.01).	Health dietary pattern (fish): BMD of the femoral neck: 0.04 g/cm² (p = 0.01).	Health dietary pattern has benefits for BMD; in contrast, adherence to a Processed dietary pattern may pose a risk for low BMD.	Meat: increases BMD Fish: increases BMD	The Rotterdam Study (population-based cohort study)
Hardcastle A.C. et al. (2011) [44]	3236 women	55.1 (±2.2)	Scotland	9 years	Healthy pattern (meat). Multiple linear regression associated with the two bone resorption markers, fPYD/Cr (free deoxypyridinoline expressed relative to creatinine) and fDPD/Cr (free pyridinoline expressed relative to creatinine), HRT use and menopausal status. fPYD/Cr: Unstandardised β: 3.42 (95% CI: 3.13, 3.72) (p < 0001); fDPD/Cr: Unstandardised β: 2.07 (95% CI: 1.76, 2.39) (p < 0001).	Healthy pattern (fish). Multiple linear regression associated with the two bone resorption markers, fPYD/Cr (free deoxypyridinoline expressed relative to creatinine) and fDPD/Cr (free pyridinoline expressed relative to creatinine), HRT (hormone replacement therapy) use and menopausal status. fPYD/Cr: Unstandardised β: 3.42 (95% CI: 3.13, 3.72) (p < 0001); fDPD/Cr: Unstandardised β: 2.07 (95% CI: 1.76, 2.39) (p < 0001).	White meat, white and oily fish and dairy products contain nutrients that are associated with good bone health.	Meat: increases BMD Fish: increases BMD	Cross-sectional study
Mu M. et al. (2014) [45]	1319 men	18.1 (±1.2)	China	1 month	Animal Protein Pattern: Meat (Lard, fat and lean meat) (Chicken, duck, goose): Hazard ratios (HR): 1.04 (p = NS)	Animal Protein Pattern: Fish (Carp, grass carp, silver carp, herring, shrimp) (Kelp laver, sea fish, seaweed) Hazard ratios (HR): 1.04 (p = NS)	The animal protein pattern was not associated with a decreased or increase risk of osteopenia or osteoporosis	Meat: no effect on BMD Fish: no effect on BMD	Cross-sectional study
Melaku Y.A. et al. (2016) [46]	1182 men and women	median 62 years	South Australia	11 years	Pattern 2 (“Western pattern”) includes high levels of processed and red meat, poultry: PR for the association between tertiles of food patterns and low bone mineral density. PR: 1.68 (95% CI: 1.02–2.77) (p < 0.05)	Pattern 1 (“prudent pattern”) includes fish PR for the association between tertiles of food patterns and low bone mineral density. PR: 0.52 (95% CI: 0.33–0.83) (p < 0.01).	Western pattern characterized by high intakes of processed and red meat was inversely associated with BMD Prudent pattern characterized by high intakes of fish was associated with higher BMD	Meat: decreases BMD Fish: increases BMD	The North West Adelaide Health Study (NWAHS)
Kontogianni M.D. et al. (2009) [47]	196 women	48 (±12)	Greek Greece	NR	A pattern characterized by high consumption of poultry (coefficient score 0.855) (component 4) BMD (lumbar bone mineral density) (g/cm²) β: 0.054 (p = NS)	A pattern characterized by high consumption of fish (coefficient score 0.867) (component 3); lumbar BMD (g/cm²) β: 0.185 (p < 0.05)	A dietary pattern characterized by high consumption of fish and low red meat intake was associated with higher BMD	Meat: no effect on BMD Fish: increases BMD	Cross-sectional study
Tucker K.L. et al. (2002) [48]	907 women and men	Men 75.1 (±4.9) Women 75.3 (±4.8)	USA	2 years	“Meat, dairy, and bread” group (n = 313) including p < 0.05: red meat, chicken BMD (±SE): Femoral neck 0.86 g/cm² (p = 0.001); in men and in women 0.74 g/cm² (p = NS); “Meat and sweet baked products” group (n = 260) including% p < 0.05: red meat, processed meat Adjusted mean (±SE) bone mineral density (BMD) “Sweet baked products” group (n = 69) including% p < 0.05: chicken Adjusted mean (±SE) bone mineral density (BMD)	“Meat, dairy, and bread” group (n = 313) including% p < 0.05: fish Adjusted mean (±SE) BMD “Sweet baked products” group (n = 69) including% p < 0.05: fish Adjusted mean (±SE) bone mineral density (BMD) “Candy” group (n = 75) including% p < 0.05: fish Adjusted mean (±SE) bone mineral density (BMD)	Men with a diet high in fruit, vegetables, and cereal (red meat and processed meat) had significantly greater BMD than did men with other dietary patterns. In contrast, those consuming the most candy (fish) had significantly lower BMD than did most other groups.	Meat: increases BMD Fish: decreases BMD	Longitudinal cohort study (The Framingham Heart Study)
Whittle C.R. et al. (2012) [49]	489 women and men	Men 22.4 (±1.6) Women 22.8 (±1.7)	Northern Ireland	2 years	Factor loading for men Factor 1: “Healthy” included meat dishes: −0.365 CC. BMD for the quintiles (Q) group of Healthy pattern determined by a posteriori principal component analysis. LS BMD (g/cm²) Q1–Q5 (p = NS). FN BMD (g/cm²) Q1–Q5 (p = NS). LS BMC (g) Q1–Q5 (p = NS). FN BMC (g) Q1–Q5 (p = NS); Factor 2: “Traditional” included red meat: 0,398 CC. Included poultry : –0.272 CC. LS BMD (g/cm²) Q1–Q5 (p = NS). FN BMD (g/cm²) Q1-Q5 (p = NS). LS BMC (g) Q1–Q5 (p = NS). FN BMC (g) Q1–Q5 (p = NS); Factor 3: “Refined” included meat dishes: 0,257 CC. LS BMD (g/cm²) Q1–Q5 (p = NS). FN (Femoral Neck) BMD (g/cm²) Q1–Q5 (p = NS). LS BMC (g) Q1–Q5 (p = NS). FN BMC (g) Q1–Q5 (p = NS) Adjusted (p < 0.05). Factor loading for women Factor 1: “Healthy” included meat dishes: −0.319 CC. LS BMD (g/cm²) Q1–Q5 (p = NS). FN BMD (g/cm²) Q1–Q5 (p = NS). LS BMC (g) Q1–Q5 (p = NS). FN BMC (g) Q1–Q5 (p = NS). Factor 2: “Traditional” included red meat: 0.299 included poultry: 0.337 LS BMD (g/cm²) Q1–Q5 (p = NS). FN BMD (g/cm²) Q1–Q5 (p = NS). LS BMC (g) Q1–Q5 (p = NS). FN BMC (g) Q1–Q5 (p = NS); Factor 3: “Nuts and Meat” included meat dishes: 0.372 LS BMD (g/cm²) Q1–Q5 (p = NS); FN (Femoral Neck) BMD (g/cm²) Q1–Q5 (p = NS) Adjusted (p < 0.05). LS BMC (g) Q1–Q5 (p = NS). FN BMC (g) Q1–Q5 (p = NS) Adjusted (p < 0.05).	Factor loading for men:Factor 4 “Social” included white fish: 0.436 CC. LS BMD (g/cm²) Q1–Q5 (p = NS); FN BMD (g/cm²) Q1–Q5 (p = NS); LS BMC (g) Q1–Q5 (p = NS). FN BMC (g) Q1–Q5 (p < 0.05) Adjusted (p = NS); Factor loading for women: Factor 1: “Healthy” included white fish: 0,325 CC. LS BMD (g/cm²) Q1–Q5 (p = NS). FN BMD (g/cm²) Q1–Q5 (p = NS); LS BMC (g) Q1–Q5 (p = NS). FN BMC (g) Q1–Q5 (p = NS).	“Refined” group scores (Factor 3 for men) (meat dishes) and “Nuts and Meat” group scores (Factor 3 for women) (meat dishes) were associated with higher FN BMC and in women also FN BMD. “Social” group scores were associated with higher FN BMC but when further adjusted were not significant.	Meat: increases BMD Fish: no effect on BMD	Longitudinal study (The Northern Ireland Young Hearts Project)
Mangano K.M. et al. (2017) [50]	2986 women and men	40.6 (±8.7)	USA	3 years	Red Meat Femoral neck (g/cm²) (n = 2903) 0.989 ± 0.006 (p = NS); Trochanter (g/cm²) (n = 2903) 0.800 ± 0.006 (p = NS); Total femur (g/cm²) (n = 2903) 1.012 ± 0.006 Lumbar spine (g/cm²) (p = NS) (n = 2831) 1.227 ± 0.009 (p = NS); Chicken Femoral neck (g/cm²) (n = 2903) 1.002 ± 0.006 (p = NS); Trochanter (g/cm²) (n = 2903) 0.806 ± 0.006 (p = NS); Total femur (g/cm²) (n = 2903) 1.022 ± 0.006 (p = NS); Lumbar spine (g/cm²) (n = 2831) 1.233 ± 0.008 (p = NS)	Fish: Femoral neck: 1.000 ± 0.006 g/cm² (n = 2903) (p = NS); Trochanter: 0.805 ± 0.006 g/cm² (n = 2903) (p = NS); Total femur 1.016 ± 0.007 g/cm² (n = 2903) (p = NS); Lumbar spine: 1.239 ± 0.009 g/cm² (n = 2831) (p = NS).	No differences at any BMD site were observed across the protein food clusters in either crude models or adjusted models.	Meat: no effect on BMD; Fish: no effect on BMD	The Framingham Third Generation Study; Longitudinal cohort study
Monma Y. et al. (2010) [51]	877 women and men	80.7 (±5.2)	Japan	4 years	Factor 2: “Meat” pattern included Pork, beef, ham, liver, Chicken. HR (95% CI) of fall-related fracture in each dietary pattern. T2 (moderately confirmed) HR: 0.36 (95% CI: 0.14–0.96); T3 (confirmed) HR: 0.36 (95% CI: 0.12–1.06) (p = NS)	Factor 2: “Meat” pattern included Shellfish, Cuttlefish, Octopus, Shrimp. HR (95% CI) of fall-related fracture in each dietary pattern. T2 (moderately confirmed) HR: 0.36 (95% CI: 0.14–0.96) T3 (confirmed) HR: 0.36 (95% CI: 0.12–1.06) (p = NS)	The “Meat” pattern had a tendency towards reduced risk of fall-related fracture.	Meat: increases BMD Fish: increases BMD	Prospective study
Okubo H. et al. (2006) [52]	291 women	40–55	Japan	3 years	Factor 3: “Western” (Processed meats and meats); Q1:0.501–0.006 g/cm² and Q5: 0.482–0.007 g/cm²; (p = NS)	Factor 1: “Healthy” (Fish and shellfish and processed fish) Q1: 0.476–0.006 g/cm²; Q5: 0.498–0.006 g/cm²; (p < 0.05)	Healthy pattern (fish) had a significantly higher BMD. No significant association was observed in the Western pattern (meat) for premenopausal women.	Meat: no effect on BMD Fish: increases BMD	Japanese Multi-centred Environmental Toxicant Study (JMETS)
Yang Y. et al. (2016) [53]	1590 boys and girls	15.1 (±1.3)	China	NR	“Meat” diet Low Bone Quality OR: T2 OR: 0.911 (95% CI 0.620–0.255); T3 OR: 0.920 (95% CI 0.626–1.354); (p = NS)	“Chinese and Western” Low Bone Quality OR: T2 OR: 0.621 (95% CI 0.512–0.832); T3 OR: 0.558 (95% CI 0.414–0.901); (p < 0.05)	The risk of low bone mineral quality could be reduced by the Chinese and Western structure.	Meat: no effect on BMD; Fish: increases BMD.	Cross-sectional study
Muraki S. et al. (2007) [54]	632 women	71.8 (±7.5)	Japan	NR	NR	Fish consumption BMD (g/cm²) 0.791 ± 0.192 T score −1.73 ± 1.59 (p = NS)	Consumption or exclusion of fish in the diet has no significant effect on bone health	Meat: NR Fish: no effect on BMD	Cross-sectional study
de Jonge E.A. et al. (2017) [55]	4028 subjects (1705 men; 2323 women)	Men 66 (61–72) Women 66 (61–73)	Netherlands	NR	Pattern: ”Sweets, animal fat, and low meat”: Osteoporotic fractures HR: 1.10 (95% CI: 1.06–1.15) (p < 0.05). HRs represent the difference in instantaneous risk of fracture per 1 z score difference in dietary pattern adherence. Hip fractures HR: 1.10 (95% CI: 1.01–1.19) (p < 0.05).	NR	Each z score of adherence to the sweets, animal fat, and low meat pattern was associated with higher bone width	Meat: increases BMD Fish: NR	Cross-sectional associations (Rotterdam Study)
Fung T.T. et al. (2015) [56]	112,845 subjects (38,305 men; 74,540 women)	Women: 30–55; Men: 40–75	USA	2 years	Relative risk (RR) (95% CI) for hip fractures according quintiles of dietary patterns: Prudent pattern (poultry and red meat): Women Q1:1–Q5: RR: 1.14 (95% CI: 0.96–1.36) (p = NS); Men Q1:1–Q5: RR: 0.86 (95% CI: 0.64-1.16) (p = NS). Western pattern (poultry and red meat): Women Q1:1–Q5: RR: 1.05 (95% CI: 0.87–1.26) (p = NS); Men Q1:1–Q5: RR: 1.03 (95% CI: 0.73–1.46) (p = NS).	NR	Neither the Prudent nor the Western dietary pattern was associated with risk of hip fractures in postmenopausal women or men over 50 years of age.	Meat: no effect on BMD Fish: NR	The Nurses’ Health Study and the Health Professionals Follow-up Study
Benetou V. et al. (2013) [7]	188,795 subjects (48,814 men; 139,981 women)	48.6 (±10.8)	Germany, Greece, Italy, Netherlands, Norway, Spain, Sweden, UK	8 years	HR for incident hip fracture per indicated increments of intake with 95% CI in overall sample: HR per 1-unit increment: 1.18 (95% CI: 1.06–1.3); men HR per 1-unit increment 1.10 (95% CI: 0.92–1.32); women HR per 1-unit increment 1.14 (95% CI: 0.99–1.31).	HR for incident hip fracture per indicated increments of intake with 95% CI in: overall sample HR per 1-unit increment 0.96 (95% CI: 0.86–1.07) men HR per 1-unit increment 0.89 (95% CI: 0.73–1.09) women HR per 1-unit increment 0.97 (95% CI: 0.85–1.12)	High meat intake was associated with increased hip fracture incidence Higher fish consumption was weakly, although not significantly, associated with lower hip fracture incidence	Meat: decrease BMD; Fish: no effect on BMD	Prospective study

* (p < 0.05); *** (p < 0.001). CI, confidence intervals. HR, Hazard ratios. CC, Correlation coefficients. FN, Femoral Neck. LS, Lumbar Spine. BMD, bone mineral density. BMC, Bone Mineral Content. ±SE, Adjusted mean. PR, Prevalence Ratio. NHANES, the National Health and Nutrition Examination Survey. OR, odds ratio. MD, Mediterranean diet. HRT, hormone replacement therapy. R², Regression coefficients. NR, not recorded. SD, standard deviation.