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

Lambert, Helen; Frassetto, Lynda; Moore, J. Bernadette; Torgerson, David; Gannon, Richard H. T.; Burckhardt, P.; Lanham-New, Susan A

doi:10.1007/s00198-014-3006-9

Cited by 51 publications

(45 citation statements)

References 36 publications

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“…A meta-analysis on 14 studies investigating the relationship between alkali salts supplementation and calcium excretion demonstrated that both urinary calcium and NAE excretion were lowered by an intervention with KHCO 3 and K-citrate (Lambert et al 2015). Clinical outcomes appear to confirm the relationship between alkali salt intake and the reduction in the developing oxalic urolithiasis.…”

Section: Urinary Stonesmentioning

confidence: 68%

“…Another prospective placebo-controlled trial performed on 201 healthy individuals (>65 year-old) affected by osteopenia and supplemented with K-citrate (60 mEq/ day for 24 months) showed a slight but significant increase in bone mass density (Jehle et al 2013). Nevertheless, a recent meta-analysis encompassing 14 interventional studies on the role of alkali on bone metabolism, although succeeded in correlating the alkali supplementation with the increase of bone turnover markers (N-telopeptide), did not demonstrate any improvement in bone mass density (Lambert et al 2015).…”

Section: Effect Of Supplementation On Bonementioning

confidence: 98%

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Diet-induced acidosis and alkali supplementation

Guardia

Roggi

Cena

2016

International Journal of Food Sciences and Nutrition

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Western diet, high in protein-rich foods and poor in vegetables, is likely to be responsible for the development of a moderate acid excess leading to metabolism deregulation and the onset or worsening of chronic disturbances. Available findings seem to suggest that diets with high protein/vegetables ratio are likely to induce the development of calcium lithiasis, especially in predisposed subjects. Moreover, some evidence supports the hypothesis of bone metabolism worsening and enhanced bone loss following acid-genic diet consumption although available literature seems to lack direct and conclusive evidence demonstrating pathological bone loss. According to other evidences, diet-induced acidosis is likely to induce or accelerate muscle wasting or sarcopenia, especially among elderlies. Furthermore, recent epidemiological findings highlight a specific role of dietary acid load in glucose metabolism deregulation and insulin resistance. The aim of this review is to investigate the role of acid-genic diets in the development of the mentioned metabolic disorders focusing on the possible clinical improvements exerted by alkali supplementation.

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Section: Urinary Stonesmentioning

confidence: 68%

Section: Effect Of Supplementation On Bonementioning

confidence: 98%

Diet-induced acidosis and alkali supplementation

Guardia

Roggi

Cena

2016

International Journal of Food Sciences and Nutrition

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“…The acid-base hypothesis postulates that the acid load is in part buffered by bone tissue, leading to bone absorption and reduced bone density [33]. FV, as a good source of alkaline precursors (e.g., K, Ca, Mg), could neutralize the calciuric effects of acids derived from the diet, as demonstrated in a recent meta-analysis [3]. In addition, vitamin C, vitamin K, and phytochemicals highly enriched in FV are involved in the synthesis of bone matrix.…”

Section: Discussionmentioning

confidence: 99%

Greater Intake of Fruit and Vegetables Is Associated with Greater Bone Mineral Density and Lower Osteoporosis Risk in Middle-Aged and Elderly Adults

et al. 2017

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ObjectiveA few studies have suggested that the consumption of fruit and vegetables (FV) may benefit bone health, but limited data are available in Asian subjects. We examined the association between FV intake and bone mineral density (BMD) and osteoporosis in Chinese adults.MethodsThis population-based cross-sectional study involved 2083 women and 1006 men aged 40–75 years in Guangzhou, China. Habitual dietary data was collected from a 79-item food frequency questionnaire by face-to-face interviews. The BMD was measured for the whole body (WB), lumbar spine (LS), total hip (TH) and femur neck (FN) with dual-energy X-ray absorptiometry.ResultsAfter adjustment for potential covariates, we observed dose-dependent associations between total FV intake and BMD and osteoporosis risk. The mean BMD was higher in tertile 3 vs. tertile 1 by 1.33% (TH) and 1.31% (FN) for FV, and 1.10% (WB), 1.57% (TH), and 2.05% (FN) for fruit (all P-trends < 0.05). Significant beneficial associations with BMD at some sites were also found in most fruit categories but not in total vegetables or their subgroups. The odds ratios (95% confidence interval) of osteoporosis (T-score ≤ −2.5) in tertile 3 (vs. 1) were 0.73 (0.58–0.92), 0.37 (0.22–0.60), and 0.71 (0.52–0.97) for FV; 0.82 (0.66–1.03), 0.48 (0.30–0.77) and 0.89 (0.61–1.12) for fruit; and 0.80 (0.64–1.01), 0.57 (0.35–0.92) and 0.76 (0.55–1.05) for vegetables at the LS, TH, and FN, respectively. The favorable association between FV intake and the occurrence of osteoporosis was evident only in subjects with lower BMI (<24.0 kg/m2, P-trends < 0.05).ConclusionsGreater intake of FV was independently associated with a higher BMD and a lower presence of osteoporosis in middle-aged and elderly Chinese subjects with lower BMI. Fruit tended to have more contribution to the favorable association than vegetables.

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“…To this purpose, some authors have suggested the use of proton pump inhibitors [13], but the long-term treatment with these drugs seems to inhibit calcium absorption and, in turn, increase the fracture risk [14]. As an alternative, supplementation with alkalizing compounds has been suggested as a tool to limit the detrimental effect of acidosis and prevent bone loss [15]. Potassium citrate (K citrate) is a potassium salt of the citric acid that is used to increase the urinary pH, thus preventing the precipitation of solutes and the formation of kidney stones [16].…”

Section: Introductionmentioning

confidence: 99%

Potassium citrate prevents increased osteoclastogenesis resulting from acidic conditions: Implication for the treatment of postmenopausal bone loss

et al. 2017

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The extracellular acidic milieu in bones results in activation of osteoclasts (OC) and inhibition of osteoblasts (OB) causing a net loss of calcium from the skeleton and the deterioration of bone microarchitecture. Alkalinization through supplementation with potassium citrate (K citrate) has been proposed to limit the osteopenia progression, even though its pharmacological activity in bone microenvironment is not well defined. We evaluated if K citrate was able to prevent the adverse effects that acidic milieu induces on bone cells. OC and OB were maintained in neutral (pH 7.4) versus acidic (pH 6.9) culture medium, and treated with different K citrate concentrations. We evaluated the OC differentiation at seven days, by counting of multinucleated cells expressing tartrate-resistant acid phosphatase, and the activity of mature OC at 14 days, by quantifying of collagen degradation. To evaluate the effects on OB, we analyzed proliferation, mineralization, and expression of bone-related genes. We found that the low pH increased OC differentiation and activity and decreased OB function. The osteoclastogenesis was also promoted by RANKL concentrations ineffective at pH 7.4. Non-cytotoxic K citrate concentrations were not sufficient to steadily neutralize the acidic medium, but a) inhibited the osteoclastogenesis, the collagen degradation, and the expression of genes involved in RANKL-mediated OC differentiation, b) enhanced OB proliferation and alkaline phosphatase expression, whereas it did not affect the in vitro mineralization, and c) were effective also in OC cultures resistant to alendronate, i.e. the positive control of osteoclastogenesis inhibition. In conclusion, K citrate prevents the increase in OC activity induced by the acidic microenvironment, and the effect does not depend exclusively on its alkalizing capacity. These data provide the biological basis for the use of K citrate in preventing the osteopenia progression resulting from low-grade acidosis.

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

Cited by 51 publications

References 36 publications

Diet-induced acidosis and alkali supplementation

Diet-induced acidosis and alkali supplementation

Greater Intake of Fruit and Vegetables Is Associated with Greater Bone Mineral Density and Lower Osteoporosis Risk in Middle-Aged and Elderly Adults

Potassium citrate prevents increased osteoclastogenesis resulting from acidic conditions: Implication for the treatment of postmenopausal bone loss

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