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The association between urinary sodium to potassium ratio and bone density in middle-aged Chinese adults

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Abstract

Summary

The joint effect of sodium and potassium on bone health remains uncertain. We examined the associations between urinary excretion of sodium, potassium, and their ratio and bone mineral density (BMD), and reported an inverse association between urinary sodium-to-potassium ratio and BMD in women, but not in men.

Introduction

Several studies have suggested that a higher sodium or lower potassium intake is associated with poor bone health. However, few studies have examined their joint effects. We examined the associations of urinary excretion of sodium, potassium, and the sodium-to-potassium ratio with BMD in Chinese adults.

Methods

This community-based, cross-sectional study included 2202 women and 1063 men (40–75 years) in Guangzhou, China. The BMD of the whole body, lumbar spine, and hip sites were measured by dual-energy x-ray absorptiometry. The concentrations of sodium, potassium, and creatinine of the fasting morning first-void urine sample were measured, and creatinine-adjusted values were then used for further analyses. General information was collected via face-to-face interviews.

Results

For women, after multivariable adjustment, the urinary sodium-to-potassium ratio was inversely associated with BMD at the whole body, total hip, trochanter, and intertrochanter (all p trend <0.05). The mean BMD differences between extreme quartiles ranged from 1.50 to 2.98 % at these sites (all p < 0.05). Similar, but less significant, associations were observed for urinary sodium/creatinine, for which the only significant difference was found at the trochanter (2.00 %, p = 0.016). We did not find any significant associations of BMD with urinary potassium in women and with urinary sodium/creatinine, potassium/creatinine, or their ratio in men.

Conclusion

Our findings suggest that the urinary sodium-to-potassium ratio, but not individual creatinine-adjusted values of sodium or potassium, is a good predictor of BMD in women, but not in men.

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Acknowledgements

This study was jointly supported by the National Natural Science Foundation of China (81273049, 81472965) and the 5010 Program for Clinical Researches (No. 2007032) of the Sun Yat-sen University (Guangzhou, China).

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Authors and Affiliations

  1. Department of Medical Statistics and Epidemiology, and Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China

    W. T. Cao, J. He, G. D. Chen, C. Wang, R. Qiu & Y. M. Chen

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  1. W. T. Cao
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  2. J. He
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  3. G. D. Chen
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  4. C. Wang
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Correspondence to Y. M. Chen.

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Conflicts of interest

Wen-ting Cao, Juan He, Geng-dong Chen, Cheng Wang, Rui Qiu, and Yu-ming Chen declare that they have no conflict of interest.

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Wen-ting Cao and Juan He contributed equally to this article

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Cao, W.T., He, J., Chen, G.D. et al. The association between urinary sodium to potassium ratio and bone density in middle-aged Chinese adults. Osteoporos Int 28, 1077–1086 (2017). https://doi.org/10.1007/s00198-016-3835-9

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  • DOI: https://doi.org/10.1007/s00198-016-3835-9

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