Osteoporosis is a worldwide public health concern. Proper nutrition plays an important role in osteoporosis prevention and treatment. This paper aims to provide a correlation between dietary diversity score and osteoporosis in Iranian elderly and provide some recommendations for improvement.

We recruited 426 elderly aged 45–85 from southeast of Iran in this study. Dual-energy X-ray absorptiometry (DXA) was used for measuring the bone mineral density of lumbar vertebrae and femoral neck. Convenience sampling method was utilized to select the participants, which included two groups: case (n = 213) and control (n = 213). Data was collected using demographic and information questionnaires, a valid 147 item food frequency questionnaire, and a physical activity questionnaire. Statistical analyses were conducted using SPSS-26, and p-values less than 0.05 were deemed to be statistically significant.

The mean ± standard deviation of dietary diversity score (DDS) was lower in participants with osteoporosis cases than in control (p < 0.001). After adjusting the confounding variables, the risk of osteoporosis had an inverse relationship with the diversity score of vegetable (OR = 0.17; 95%CI: 0.06–0.24), bread and cereal (OR = 0.31; 95% CI: 0.04–0.75) and fruit (OR = 0.36; 95%CI: 0.26–0.49) (p < 0.05). Nevertheless, no visible correlation was seen between the triads of DDS, dairy and meat diversity score, and osteoporosis.

The study found the significance of addressing osteoporosis risk with the diversity score of food in older adults. Healthcare policymakers and administrators can use these findings to identify and alleviate dominant factors contributing to osteoporosis.