Potential renal acid load may more strongly affect bone size and mass than volumetric bone mineral density

The effect of supplementation with alkaline potassium salts on bone metabolism: a meta-analysis

“…Alternatively, the diets of the women in the Scottish study were not sufficiently acidogenic for a beneficial effect of alkaline potassium salts to be demonstrated [34]. It has also been suggested that areal BMD measured by DEXA may not be the most appropriate outcome for assessing the effects of nutritional factors on bone [35]. The main limitation of this analysis is the heterogeneity of included studies in terms of study design, primary outcome measures and populations studied.…”

Dietary acid load and bone turnover during long-duration spaceflight and bed rest

“…Total BMD and BMC were not related to NEAP, and it is possible that the diet effects on these whole-body measurements were swamped by the protective effect of exercise. Furthermore, Remer and colleagues (47) have suggested that the potential renal acid load of the diet may be more related to the cortical area of the bone (bone size), as assessed by peripheral quantitative computed tomography (pQCT), and not to areal BMD, as assessed by DXA. This hypothesis is based on previous pQCT findings that dietary potential renal acid load was associated with cortical area and BMC but not with volumetric cortical BMD (48).…”

“…This hypothesis is based on previous pQCT findings that dietary potential renal acid load was associated with cortical area and BMC but not with volumetric cortical BMD (48). Remer et al (47) argue that true volumetric density, bone thickness, and bone size are integrated into a single number with DXA, and the acid load of the diet may be more closely related to bone size and bone mass than to the BMD measurement. We unfortunately do not have any pQCT data for the crew members in this study, but the relation between dietary acid load and impact on bone is worth testing in the future.…”