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Bicarbonate, but Not Potassium, Decreases Resorption

Abstract

Treatment with potassium bicarbonate lowers calcium excretion and bone resorption in older men and women.

Bicarbonate has been implicated in bone health in older subjects on acid-producing diets in short-term studies.
The objective of this study was to determine the effects of potassium bicarbonate and its components on changes in bone resorption and calcium excretion over 3 months in older men and women. Design, Participants, and Intervention: In this double-blind, controlled trial, 171 men and women age 50 and older were randomized to receive placebo or 67.5 mmol/d of potassium bicarbonate, sodium bicarbonate, or potassium chloride for 3 months. All subjects received calcium (600 mg of calcium as triphosphate) and 525 IU of vitamin D(3) daily.
Twenty-four-hour urinary N-telopeptide and calcium were measured at entry and after 3 months. Changes in these measures were compared across treatment groups in the 162 participants included in the analyses.
Bicarbonate affected the study outcomes, whereas potassium did not; the two bicarbonate groups and the two no bicarbonate groups were therefore combined. Subjects taking bicarbonate had significant reductions in urinary N-telopeptide and calcium excretion, when compared with subjects taking no bicarbonate (both before and after adjustment for baseline laboratory value, sex, and changes in urinary sodium and potassium; P = 0.001 for both, adjusted). Potassium supplementation did not significantly affect N-telopeptide or calcium excretion.
Bicarbonate, but not potassium, had a favorable effect on bone resorption and calcium excretion. This suggests that increasing the alkali content of the diet may attenuate bone loss in healthy older adults.

Dawson-Hughes B, Harris SS, Palermo NJ, Castaneda-Sceppa C…
J. Clin. Endocrinol. Metab. Jan 2009
PMID: 18940881 | Free Full Text

Supplementation with potassium did not significantly alter calcium excretion or markers of bone turnover in this study. This is in contrast to earlier reports of Lemann et al. (19) and Jones et al. (20) who found that increasing potassium intake decreased urinary calcium excretion. The apparently conflicting observation that higher potassium intake is associated with higher BMD in healthy perimenopausal women (21) may result from the fact that potassium-rich diets tend to be alkali-producing, in that they are rich in fruits and vegetables. Treatment with potassium did enhance sodium excretion, as has been documented widely.

In conclusion, we have found that reducing the acidogenicity of the diet into the alkali-producing range with bicarbonate lowers calcium excretion and the bone resorption rate in healthy older men and women consuming rather typical acid-producing American diets. Treatment with 67.5 mmol/d of potassium bicarbonate was safe and well tolerated in this population. Increasing intake of alkali merits further consideration as a safe and low-cost approach to improving skeletal health in older men and women.

Policosanol Prevents Bone Loss in Ovariectomized Rats

Abstract

Policosanol prevents bone loss in ovariectomized rats.

Osteoporosis is characterized by reduced bone mass, abnormal bone architecture and increased fracture risk. Ovariectomy impairs bone mass and metabolism in rats and ovariectomized rats are considered as a suitable model of postmenopausal osteoporosis. Mevalonate is required for producing lipoids that are important in osteoclast activity and thus drugs affecting mevalonate production can prevent bone loss in rodents. Policosanol is a cholesterol-lowering drug isolated from sugar cane wax that inhibits cholesterol biosynthesis through an indirect regulation of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase activity. The purpose of this study was to determine whether policosanol could prevent bone loss in the bones of ovariectomized rats by comparing its effects with those induced by estradiol. Sprague Dawley female rats were randomly distributed in four groups: a sham-operated group treated with Tween/H2O vehicle and three groups of ovariectomized rats treated with 17beta-estradiol (30 microg/kg/day) or policosanol (50 and 200 mg/kg/day), respectively, for 3 months. At treatment completion the rats were sacrificed, their bones removed and variables of bone resorption and formation were investigated by histomorphometry. Ovariectomy increased trabecular separation but diminished the number and thickness of trabecules. Estradiol and policosanol prevented these effects compared with ovariectomized controls. Both treatments also prevented an increase in the number of osteoclasts and their surface area induced by ovariectomy. Estradiol, but not policosanol, significantly prevented an increase of osteoblast surface area compared with ovariectomized controls. In conclusion, policosanol prevented bone loss and decreased bone resorption in ovariectomized rats, suggesting that it should be potentially useful in preventing bone loss in postmenopausal women.

Noa M, Más R, Mendoza S, Gámez R…
Drugs Exp Clin Res 2004
PMID: 15366788

Sodium Associated with Lower Bone Density in Young Women

Abstract

Higher urinary sodium, a proxy for intake, is associated with increased calcium excretion and lower hip bone density in healthy young women with lower calcium intakes.

We assessed 24-h urinary sodium (Na) and its relationship with urinary calcium (Ca) and areal bone mineral density (aBMD) at the whole body, lumbar spine and total hip in a cross-sectional study. 102 healthy non-obese women completed timed 24-h urine collections which were analyzed for Na and Ca. Dietary intakes were estimated using a validated food frequency questionnaire. Participants were grouped as those with lower vs. higher calcium intake by median split (506 mg/1000 kcal). Dietary Na intake correlated with 24-h urinary loss. Urinary Na correlated positively with urinary Ca for all participants (r = 0.29, p < 0.01) and among those with lower (r = 0.37, p < 0.01) but not higher calcium intakes (r = 0.19, p = 0.19). Urinary Na was inversely associated with hip aBMD for all participants (r = -0.21, p = 0.04) and among women with lower (r = -0.36, p < 0.01) but not higher (r = -0.05, p = 0.71) calcium intakes. Urinary Na also entered a regression equation for hip aBMD in women with lower Ca intakes, contributing 5.9% to explained variance. In conclusion, 24-h urinary Na (a proxy for intake) is associated with higher urinary Ca loss in young women and may affect aBMD, particularly in those with lower calcium intakes.

Bedford JL, Barr SI
Nutrients Nov 2011
PMID: 22254088 | Free Full Text

The potential implications of sodium-induced calciuria for bone are likely to be more serious in those with low calcium intakes, who may be unable to increase calcium absorption to fully compensate for increased urinary losses. For example, Heaney [3] noted that to offset the average urinary calcium loss of 1 mmol (40 mg) associated with an increased sodium intake of 100 mmol (2300 mg), gross calcium absorption efficiency would need to increase to 34% (from 25%) in those with intakes of 600 mg/day, and to about 50% (from 37%) in those with intakes of 300 mg/day-and that this may not be possible. However, at intakes of 1200 mg/day, absorption efficiency would only need to increase from to 23% (from 20%) [3]. Empirical support for the idea that high calcium intakes may protect against high sodium intakes is provided by the study of Ilich et al. [20]. In a 3-year prospective study, postmenopausal women were randomly assigned to maintain usual sodium intake of about 3000 mg/day or to reduce intake to 1500 mg/day. All women also received calcium supplements, and total calcium intake averaged over 1300 mg/day. Because compliance with the sodium intervention was not high, results were reported by tertile of observed urinary sodium excretion rather than by initial group assignment. No negative associations between urinary sodium and bone density were observed [20]. This suggests that, at least in postmenopausal women with high calcium intakes, sodium intake does not adversely affect bone.

Higher Sodium + Adequate Calcium is Not Detrimental for Bone in Women

Abstract

Higher habitual sodium intake is not detrimental for bones in older women with adequate calcium intake.

Based on the calciuric effect of sodium (Na), it has been speculated, although not proven, that higher Na intake might have a detrimental effect on bone health. The objective was to determine the relationship between Na intake (expressed as urinary Na) and bone mineral density/content (BMD/BMC) during a 3-year study. Participants were healthy, postmenopausal, Caucasian women (n = 136 at baseline) with no medications affecting bone. After baseline screening, half were instructed to reduce sodium intake to approximately 1,500 mg/day (intervention). The other half remained on habitual intake of approximately 3,000 mg/day (control). All subjects were given calcium and vitamin D supplements to achieve recommended levels. Anthropometries, densitometry, blood and 24-h urine analyses, and dietary and activity records were assessed every 6 months. Data were analyzed as a continuum, irrespective of the initial assignment to a control or intervention group, using random effects regressions with repeated measures analysis of variance to examine changes over time. Results showed that subjects with higher Na intake had higher BMD in the forearm and spine at baseline and all subsequent time-points (p < 0.01). In the forearm, time and higher urinary calcium modified results, producing a curvilinear decrease in BMD (p < 0.01). In the spine, more active individuals had higher BMD at all time-points. We conclude that higher sodium intake, within the range consumed, had a positive effect on some skeletal sites and no adverse effect on bone in women who had adequate calcium and vitamin D intake.

Ilich JZ, Brownbill RA, Coster DC
Eur. J. Appl. Physiol. Jul 2010
PMID: 20217116

Low Sodium may be Risk Factor for Maintaining Calcium and Magnesium

Abstract

Positive correlation between dietary intake of sodium and balances of calcium and magnesium in young Japanese adults–low sodium intake is a risk factor for loss of calcium and magnesium–.

The content of calcium (Ca) and magnesium (Mg) in sweat during exercise is considerably higher during a relatively low intake of sodium (Na) of 100 mmol/d than with an intake of 170 mmol/d. For this reason and also because Ca and Mg have a negative balance with a Na intake of 100 mmol/d, we analyzed the relationship between Na intake and balances of Ca and Mg in data from 11 balance studies. From 1986 to 2000, 109 volunteers (23 males, 86 females) with an age range of 18 to 28 y took part in mineral balance studies. The balance periods ranged from 5 to 12 d. In a given experiment, the diet of each subject contained the same quantity of food, although this varied between experiments, and was supplied during the balance period without consideration of body weight. In the data of all the studies (n= 109), the balances of Ca and Mg did not correlate positively with Na intake. However, when the data of the highest Na study were excluded, the balances of Ca and Mg correlated positively with Na intake. The mean value for the regression equation between Na intake and Ca and Mg balances when the respective balance was equal to zero were, 63.308 mg Na/kg BW/d (Ca: n=96, r2=0.134) and 60.977 mg Na/kg BW/d (Mg: n=96, r2=0.268), respectively. These values are considerably higher than Na requirements estimated by inevitable Na loss. Low dietary Na may therefore be a risk factor for maintaining positive balances of Ca and Mg.

Nishimuta M, Kodama N, Morikuni E, Yoshioka YH…
J. Nutr. Sci. Vitaminol. Aug 2005
PMID: 16261999

DASH Diet and Sodium Reduction Improve Bone in Adults

Abstract

The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults.

Dietary strategies to prevent and treat osteoporosis focus on increased intake of calcium and vitamin D. Modification of whole dietary patterns and sodium reduction may also be effective. We examined the effects of two dietary patterns and three sodium levels on bone and calcium metabolism in a randomized feeding study. A total of 186 adults, aged 23-76 y, participated. After a 2-wk run-in period, participants were assigned randomly to diets containing three levels of sodium (50, 100 and 150 mmol/d) to be consumed for 30 d in random order. Serum osteocalcin (OC), C-terminal telopeptide of type I collagen (CTX), fasting serum parathyroid hormone (PTH), urinary sodium, potassium, calcium and cAMP were measured at baseline and at the end of each sodium period. The Dietary Approaches to Stop Hypertension (DASH) diet reduced serum OC by 8-11% and CTX by 16-18% (both P < 0.001). Urinary calcium excretion did not differ between subjects that consumed the DASH and control diets. Reducing sodium from the high to the low level significantly decreased serum OC 0.6 microg/L in subjects that consumed the DASH diet, fasting serum PTH 2.66 ng/L in control subjects and urinary calcium 0.5 mmol/24 h in both groups. There were no consistent effects of the diets or sodium levels on urinary cAMP. In conclusion, the DASH diet significantly reduced bone turnover, which if sustained may improve bone mineral status. A reduced sodium intake reduced calcium excretion in both diet groups and serum OC in the DASH group. The DASH diet and reduced sodium intake may have complementary, beneficial effects on bone health.

Lin PH, Ginty F, Appel LJ, Aickin M…
J. Nutr. Oct 2003
PMID: 14519796 | Free Full Text

Low Sodium Causes Body to Rob Bones of Sodium, Calcium and Magnesium in Women

Abstract

Negative balance of calcium and magnesium under relatively low sodium intake in humans.

The balance of minerals (sodium [Na], potassium [K], calcium [Ca], and magnesium [Mg]) was measured in six female students for 10 d while under a relatively low Na intake (100 mmol/d or 2.2 g/d) with receiving adequate Ca (20 mmol/d or 800 mg/d) and Mg (12 mmol/d or 280 mg/d). Both the plasma renin activity (PRA) and aldosterone level were above the reference ranges throughout the experiment, which implied that the subjects were Na deficient. However, the urine Na excretion was about the same as that ingested, while there was no substantial reduction of sweat Na concentration observed during moderate physical exercise (13.2+/-2.6 mmol/L) (mean+/-SD). On the other hand, the urine Ca and Mg levels were high, but the apparent absorption of Ca and Mg was moderate (21 +/- 5%, 34 +/- 4%, respectively), which resulted in a negative balance of these two elements. It seems that the stored Na in the bone is eluted so as to compensate for the low dietary Na intake, while any excess Ca and Mg also inevitably flows into the blood stream with Na, which inhibited the intestinal absorption of both Ca and Mg and accelerates their excretion in urine.

Kodama N, Nishimuta M, Suzuki K
J. Nutr. Sci. Vitaminol. Jun 2003
PMID: 12953799

ACE Inhibitors, But Not ARBs, Marginally Increase Bone Loss in Men

Abstract

Does the use of ACE inhibitors or angiotensin receptor blockers affect bone loss in older men?

In a prospective cohort study of 5,995 older American men (MrOS), users of angiotensin-converting enzyme (ACE) inhibitors had a small but significant increase in bone loss at the hip over 4 years after adjustment for confounders. Use of angiotensin II AT1 receptor blockers (ARB) was not significantly associated with bone loss.
Experimental evidence suggests that angiotensin II promotes bone loss by its effects on osteoblasts. It is therefore plausible that ACE inhibitor and ARB may reduce rates of bone loss. The objective of this study is to examine the independent effects of ACE inhibitor and ARB on bone loss in older men.
Out of 5,995 American men (87.2%) aged ≥65 years, 5,229 were followed up for an average of 4.6 years in a prospective six-center cohort study-The Osteoporotic Fractures in Men Study (MrOS). Bone mineral densities (BMD) at total hip, femoral neck, and trochanter were measured by Hologic densitometer (QDR 4500) at baseline and year 4.
Out of 3,494 eligible subjects with complete data, 1,166 and 433 subjects reported use of ACE inhibitors and ARBs, respectively. When compared with nonusers, continuous use of ACE inhibitors was associated with a small (0.004 g/cm(2)) but significant increase in the average rate of BMD loss at total hip and trochanter over 4 years after adjustment for confounders. Use of ARB was not significantly associated with bone loss.
Use of ACE inhibitors but not ARB may marginally increase bone loss in older men.

Kwok T, Leung J, Zhang YF, Bauer D…
Osteoporos Int Aug 2012
PMID: 22080379

 

Coffee Not Associated with Bone Density in Premenopausal Korean Women

Abstract

Coffee consumption and bone mineral density in korean premenopausal women.

Although Asian people are known to have lower bone mass than that of Caucasians, little is known about coffee-associated bone health in Asian. This study aimed to assess the relationship between coffee consumption and bone mineral density (BMD) in Korean premenopausal women.
Data were obtained from the Fourth Korea National Health and Nutrition Examination Survey 2008-2009. The study population consisted of 1,761 Korean premenopausal women (mean age 36 years) who were measured for lumbar spine and femoral neck BMD and who completed a standardized questionnaire about coffee intake frequency. We excluded the participants who took hormone replacement therapy or medication for osteoporosis. The cross-sectional relationship between coffee consumption and impaired bone health (osteopenia or osteoporosis) was investigated by bone densitometry.
Coffee consumption showed no significant association with BMD of either femoral neck or lumbar spine, independent of other factors. The adjusted odds ratios for BMD for those who consumed once in a day, twice a day and three times a day were 0.94 (0.70-1.26), 0.93 (0.67-1.28), and 1.02 (0.69-1.50), respectively (P for trend = 0.927).
This study does not support the idea that coffee is a risk factor for impaired bone health in Korean premenopausal women.

Choi EJ, Kim KH, Koh YJ, Lee JS…
Korean J Fam Med Jan 2014
PMID: 24501665 | Free Full Text

 This study shows that high consumption of coffee is not associated with increased risk for impaired bone health. Our results are in agreement with some recent cross-sectional studies showing no association between caffeine and impaired bone health, and in disagreement with others which focused on BMD of various skeletal sites.22-26) Habitual dietary caffeine intake was found not to be associated with impaired bone health in healthy postmenopausal women in a longitudinal study in Pennsylvania (USA), on the basis of self-reported questionnaires collected in 2000.23) In elderly men and women from the population-based Framingham Osteoporosis Study, the same results were found.24) These studies are in agreement with our study. Although the frequency consumed and the species of coffee could be significantly affected by cultural differences and socioeconomic status, and the metabolism of caffeine and other constituents can be affected by genetic predisposition, our results in Korean premenopausal women did not appear to contradict those of previous studies.

The role of coffee intake in bone health, however, seems controversial. There are several studies showing a negative association between caffeine and bone health. Daily intake of 330 mg of caffeine, equivalent to 4 cups (600 mL) of coffee, or more may be associated with a modestly increased risk of osteoporotic fractures, especially in women with a low intake of calcium, as shown in a study on Swedish women aged 40 to 76 years.4) Also, in a cohort study, Men consuming 4 cups of coffee or more per day had 4% lower BMD at the proximal femur (P = 0.04) compared with low or non-consumers of coffee. This difference was not observed in women, suggesting that rapid metabolizers of caffeine may constitute a risk group for bone loss induced by coffee.24)

Caffeine >330 mg/day Associated with Fractures in Swedish Women

Abstract

Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women.

Consumption of coffee and tea, and total intake of caffeine has been claimed to be associated with osteoporotic fracture risk. However, results of earlier studies lack consistency.
We examined this relation in a cohort of 31,527 Swedish women aged 40-76 years at baseline in 1988. The consumption of coffee, caffeinated tea and the intake of caffeine were estimated from a self-administered food frequency questionnaire (FFQ). Multivariate-adjusted hazards ratios (HRs) of fractures with 95% confidence intervals (95% CIs) were estimated by Cox proportional hazards models.
During a mean follow-up of 10.3 years, we observed 3,279 cases with osteoporotic fractures. The highest (>330 mg/day) compared with the lowest (<200 mg/day) quintile of caffeine intake was associated with a modestly increased risk of fracture: HR 1.20 (95% CI: 1.07-1.35). A high coffee consumption significantly increased the risk of fracture (p for trend 0.002), whereas tea drinking was not associated with risk. The increased risk of fracture with both a high caffeine intake and coffee consumption was confined to women with a low calcium intake (<700 mg/day): HR 1.33 (95% CI: 1.07-1.65) with > or =4 cups (600 ml)/day of coffee compared to <1 cup (150 ml)/day. The same comparison but risk estimated for women with a high propensity for fractures (> or =2 fracture types) revealed a HR of 1.88 (95% CI: 1.17-3.00).
In conclusion, our results indicate that a daily intake of 330 mg of caffeine, equivalent to 4 cups (600 ml) of coffee, or more may be associated with a modestly increased risk of osteoporotic fractures, especially in women with a low intake of calcium.

Hallström H, Wolk A, Glynn A, Michaëlsson K
Osteoporos Int 2006
PMID: 16758142