Dietary protein and bone health: a systematic review and meta-analysis

Darling, A. L.; Millward, D. J.; Torgerson, David; Hewitt, Catherine; Lanham-New, Susan A

doi:10.3945/ajcn.2009.27799

Cited by 272 publications

(235 citation statements)

References 76 publications

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“…Depending on measurement site, dietary factors, including total energy intake and dietary intakes of protein, Ca, vitamin D and K, strengthened or attenuated the association between alcohol and BMD. The latter have been identified as the most evident dietary factors affecting BMD in the literature (37)(38)(39)(40)(41) and were therefore added to the analysis. These findings suggest that low alcohol consumption has an independent effect on BMD.…”

Section: Discussionmentioning

confidence: 99%

Alcohol consumption and bone mineral density in elderly women

Sommer

Erkkilä

Järvinen

et al. 2012

Public Health Nutr.

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Objective: Findings regarding alcohol consumption and bone mineral density (BMD) in elderly women have been inconsistent. The objective of the present study was to explore the association of alcohol intake with BMD in elderly women. Design: This cohort study included women from the population-based Kuopio Osteoporosis Risk Factor and Prevention -Fracture Prevention Study (OSTPRE-FPS). Alcohol intake and potential confounders were assessed at baseline and after 3 years of follow-up using a lifestyle questionnaire. In addition, an FFQ was distributed in the third year to measure dietary intake, including alcohol. Women underwent BMD measurements at the femoral neck and lumbar spine at baseline and after 3 years of follow-up. Setting: Kuopio Province, Finland. Subjects: Three hundred elderly women (mean age 67?8 years) who provided both BMD measurements and FFQ data. Results: Alcohol consumption estimated from the FFQ and lifestyle questionnaire was significantly associated with BMD at both measurement sites after adjustment for potential confounders, including lifestyle and dietary factors (P , 0?05). Using the FFQ, women drinking .3 alcoholic drinks/week had significantly higher BMD than abstainers, 12?0 % at the femoral neck and 9?2 % at the lumbar spine. Results based on the lifestyle questionnaire showed higher BMD values for all alcohol-consuming women at the femoral neck and for women drinking 1-3 alcoholic beverages/week at the lumbar spine, compared with non-users. Conclusions:The results from OSTPRE-FPS suggest that low to moderate alcohol intake may exert protective effects on bone health in elderly women.

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Section: Discussionmentioning

confidence: 99%

Alcohol consumption and bone mineral density in elderly women

Sommer

Erkkilä

Järvinen

et al. 2012

Public Health Nutr.

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“…43 A number of meta-analyses have questioned the hypothesis that the diet net acid load reduces bone mass. 10,47,48,49 Mean estimated dietary NEAP is in the order of þ 40 mEq/day, whereas estimated urinary PRAL is low. If these women were eating generally healthy diets, although dietary acidity was positive, it was perhaps insufficiently acidic enough (as indicated by the negative urinary PRAL) so that the additional alkaline-generating potassium salts did not benefit BMD.…”

Section: Discussionmentioning

confidence: 99%

No evidence that the skeletal non-response to potassium alkali supplements in healthy postmenopausal women depends on blood pressure or sodium chloride intake

et al. 2012

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BACKGROUND/OBJECTIVES:In vitro studies demonstrate that bone is degraded in an acidic environment due to chemical reactions and through effects on bone cells. Clinical evidence is insufficient to unequivocally resolve whether the diet net acid or base load bone affects breakdown in humans. Increasing dietary salt (sodium chloride, NaCl) mildly increases blood acidity in humans and in rats with increased sensitivity to the blood pressure effects of salt, whereas increased potassium (K) intake can decrease blood pressure. Blood pressure responses to NaCl or K may potentially be a marker for increased bone turnover or lower bone mineral density (BMD) in women at higher risk for osteoporosis and fracture. SUBJECTS/METHODS: We retrospectively analysed data from two data sets (California and NE Scotland) of postmenopausal women (n ¼ 266) enrolled in long-term randomized, placebo-controlled studies of the effects of administration of low-or high-dose dietary K alkali supplementation on bone turnover in relation to sodium or chloride excretion (a marker of dietary salt intake). Mean arterial pressure (MAP) was calculated from blood pressure measures, MAP was divided into tertiles and its influence on the effect of dietary NaCl and K alkali supplementation on deoxypyridinoline markers of bone resorption and BMD by DEXA was tested. Data was analysed for each data set separately and then combined. RESULTS: Percentage change in BMD after 24 months was less for California compared with North East Scotland (hip: À 0.6 ± 2.8% and À 1.5±2.4%, respectively (P ¼ 0.027); spine: À 0.5±3.4% and À 2.6±3.5%, (Po0.001). We found no effect of dietary alkali treatment on BMD change or bone resorption for either centre. Adjusting for the possible calcium-or potassium-lowering effects on blood pressure did not alter the results. CONCLUSIONS: Blood pressure responses to Na, Cl or K intake did not help predict a BMD response to diet alkali therapy.

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“…Conversely, dietary protein is a source of metabolic acid that may lower the pH of urine and increase urinary calcium excretion, which could lower bone mass,3 although a meta‐analyses of randomized trials reported that higher protein intakes are not detrimental to calcium retention or bone mineral loss 4. A systematic review on the relationship between protein and bone health reported no adverse associations between protein intake and bone mineral density (BMD) and a meta‐analysis of six randomized controlled trials showed a beneficial effect of protein supplementation (40 mg of milk basic protein or 20.4 g total protein) on lumbar spine BMD of 0.02 g/cm 2 5. A number of cross‐sectional and prospective studies have also reported associations between higher total protein intake and higher BMD in women 6, 7, 8, 9.…”

Section: Introductionmentioning

confidence: 99%

Amino Acid Intakes Are Associated With Bone Mineral Density and Prevalence of Low Bone Mass in Women: Evidence From Discordant Monozygotic Twins

Jennings

Macgregor

Spector

et al. 2015

Journal of Bone and Mineral Research

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Although a higher protein intake, particularly from vegetable sources, has been shown to be associated with higher bone mineral density (BMD) the relative impact of specific amino acids on BMD and risk of osteoporosis remains to be determined. Mechanistic research suggests that a number of specific amino acids, including five nonessential amino acids—alanine, arginine, glutamic acid, glycine, and proline—may play a role in bone health, principally through improved production of insulin and insulin‐like growth factor 1 and the synthesis of collagen and muscle protein. However to date, no previous studies have examined the associations between habitual intake of amino acids and direct measures of BMD and prevalence of osteoporosis or osteopenia, and no studies have examined this relationship in discordant identical twin‐pairs. In these analyses of female monozygotic twin‐pairs discordant for amino acid intake (n = 135), twins with higher intakes of alanine and glycine had significantly higher BMD at the spine than their co‐twins with within‐pair differences in spine‐BMD of 0.012 g/cm2 (SE 0.01; p = 0.039) and 0.014 g/cm2 (SE 0.01; p = 0.026), respectively. Furthermore, in cross‐sectional multivariable analyses of 3160 females aged 18 to 79 years, a higher intake of total protein was significantly associated with higher DXA‐measured BMD at the spine (quartile Q4 to quartile Q1: 0.017 g/cm2, SE 0.01, p = 0.035) and forearm (Q4 to Q1: 0.010 g/cm2, SE 0.003, p = 0.002). Intake of six amino acids (alanine, arginine, glutamic acid, leucine, lysine, and proline) were associated with higher BMD at the spine and forearm with the strongest association observed for leucine (Q4 to Q1: 0.024 g/cm2, SE 0.01, p = 0.007). When intakes were stratified by protein source, vegetable or animal, prevalence of osteoporosis or osteopenia was 13% to 19% lower comparing extreme quartiles of vegetable intake for five amino acids (not glutamic acid or proline). These data provide evidence to suggest that intake of protein and several amino acids, including alanine and glycine, may be beneficial for bone health, independent of genetic background. © 2015 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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Dietary protein and bone health: a systematic review and meta-analysis

Cited by 272 publications

References 76 publications

Alcohol consumption and bone mineral density in elderly women

Alcohol consumption and bone mineral density in elderly women

No evidence that the skeletal non-response to potassium alkali supplements in healthy postmenopausal women depends on blood pressure or sodium chloride intake

Amino Acid Intakes Are Associated With Bone Mineral Density and Prevalence of Low Bone Mass in Women: Evidence From Discordant Monozygotic Twins

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