Effectiveness of anthocyanin-rich foods on bone remodeling biomarkers of middle-aged and older adults at risk of osteoporosis: a systematic review, meta-analysis, and meta-regression.

This systematic review and meta-analysis evaluated the effects of anthocyanin-rich foods on bone remodeling biomarkers and bone mineral density (BMD) in middle-aged and older adults (≥40 years) at risk of osteoporosis. Thirteen randomized controlled trials (RCTs) involving 729 participants, primarily postmenopausal women and some older men, were analyzed. While anthocyanin-rich food consumption showed statistically nonsignificant effects on most bone remodeling biomarkers—including bone-specific alkaline phosphatase (BALP) and receptor activator of nuclear factor kappa-B ligand (RANKL)—a significant increase was observed in lumbar spine (L1–L4) BMD. Subgroup analyses indicated that berries had a larger effect on RANKL than plums, and factors such as body mass index, dietary intake, and attrition rates moderated outcomes. The overall certainty of evidence was low due to unclear risk of bias and small sample sizes, highlighting the need for larger, high-quality RCTs to confirm these findings and clarify anthocyanins' role in bone health.