Skipping breakfast and late dinners tied to higher risk of osteoporotic fractures in large Japanese study
Analysis of nearly 927,000 insurance records finds meal timing behaviors independently associated with fractures after a median 2.6 years of follow-up
Researchers in Japan reported that skipping breakfast and eating dinner late were independently associated with an increased risk of osteoporotic fractures in a large observational study of adults who underwent routine health checkups.
The study, conducted by investigators at Nara Medical University, analyzed records for 927,130 people aged 20 and older drawn from an insurance claims database. Participants had health checkups between April 1, 2014, and Feb. 28, 2022, and were followed for a median of approximately 2.6 years to identify new fractures of the hip, spine, forearm or humerus.
Investigators reported that the associations with meal timing remained after accounting for conventional risk factors, including older age and lower body mass index. The analysis found that the specific eating behaviors of skipping breakfast and having a late evening meal were linked to a higher likelihood of sustaining an osteoporotic fracture during the follow-up period.
Osteoporosis is a condition marked by reduced bone mineral density and decreased bone mass, often progressing without symptoms until a fracture occurs. Common fracture sites include the hip, spine and wrist; such fractures are associated with pain, disability and increased health care utilization, particularly among older adults.
The research team used combined insurance claims and health-check data to identify fracture outcomes and to characterize participants’ demographic and clinical profiles. The median age of the cohort was about 67 years, and 55% of participants were female. The investigators tracked incident fractures of key osteoporotic sites — hip, spine, forearm and humerus — as the primary outcomes.
Because the study was observational, it cannot establish a causal relationship between meal timing and fracture risk. The authors noted that unmeasured confounding factors and the limitations of claims and routine health-check data could affect results. The findings do, however, add to a growing literature that links lifestyle and behavioral factors with bone health beyond established risk elements such as age, sex, low body mass index, smoking, alcohol use and underlying medical conditions.
Public health experts emphasize that osteoporosis often goes undiagnosed until a fracture occurs, making identification of potentially modifiable risk factors important for prevention. Standard clinical approaches to reducing fracture risk include assessment of bone mineral density, management of osteoporosis medications when indicated, fall prevention strategies and attention to nutrition, including adequate calcium and vitamin D intake.
The researchers’ analysis suggests that meal timing — specifically skipping the morning meal and consuming dinner late — warrants further study as a possible contributor to bone health. They recommend additional research to clarify mechanisms and to determine whether interventions that change eating patterns could influence long-term bone outcomes.
Clinicians and public health practitioners may consider these findings in the context of broader preventive strategies, but the observational nature of the study means changes in clinical practice should await confirmatory research, including studies that can better account for diet quality, physical activity, medication use and other potential confounders.
The study adds to an expanding body of evidence linking daily lifestyle patterns to chronic disease risk and underscores the importance of comprehensive approaches to osteoporosis prevention and bone health promotion.