Context
Hip fractures are a major public health concern. Understanding their epidemiologic and biological links with diet and cardiovascular risk may have important implications for prevention.

Objective
To assess the dose-response association of Mediterranean diet (MD) adherence with the risk of hip fracture.

Data Sources
A systematic search was conducted in the PubMed, Scopus, and Web of Science databases for prospective studies. Search terms were “Mediterranean Diet” and “Fracture.”

Data extraction
Data were extracted from 8 studies, encompassing 15 cohorts that included 503 174 individuals. Methodological quality was assessed using the Risk of Bias in Nonrandomized Studies of Interventions.

Data Analysis
The “meta” and “dosresmeta” packages were used in R Studio Software. The results demonstrated that high and moderate MD adherence were associated with a reduced risk of hip fracture (relative risk [RR] = 0.71 [95% CI, 0.55-0.91]; and RR = 0.78[(95% CI, 0.65-0.93], respectively). The effect of the association was similar in men and women. The dose-response pattern of the association was linear: each point increase in MD adherence was associated with a 5.25% reduction in hip fracture risk.

Conclusions
Adherence to MD is associated with a reduction in hip fracture risk, following a linear dose-response pattern. This supports the promotion of this dietary pattern for improving bone health.