Clinical Investigations

Calcified Tissue International

, Volume 50, Issue 1, pp 14-18

First online:

Cross-cultural association between dietary animal protein and hip fracture: A hypothesis

  • Benjamin J. AbelowAffiliated withYale University School of Medicine
  • , Theodore R. HolfordAffiliated withDepartment of Epidemiology and Public Health, Section of Endocrinology, Yale University School of Medicine
  • , Karl L. InsognaAffiliated withDepartment of Medicine, Section of Endocrinology, Yale University School of Medicine

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Age-adjusted female hip fracture incidence has been noted to be higher in industrialized countries than in nonindustrialized countries. A possible explanation that has received little attention is that elevated metabolic acid production associated with a high animal protein diet might lead to chronic bone buffering and bone dissolution. In an attempt to examine this hypothesis, cross-cultural variations in animal protein consumption and hip fracture incidence were examined. When female fracture rates derived from 34 published studies in 16 countries were regressed against estimates of dietary animal protein, a strong, positive association was found. This association could not plausibly be explained by either dietary calcium or total caloric intake. Recent studies suggest that the animal protein-hip fracture association could have a biologically tenable basis. We conclude that further study of the metabolic acid-osteoporosis hypothesis is warranted.

Key words

Osteoporosis Hip fracture Acid-base equilibrium Vegetarianism Dietary proteins Epidemiology