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Dietary protein and bone health across the life-course: an updated systematic review and meta-analysis over 40 years

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Abstract

We undertook a systematic review and meta-analysis of published papers assessing dietary protein and bone health. We found little benefit of increasing protein intake for bone health in healthy adults but no indication of any detrimental effect, at least within the protein intakes of the populations studied. This systematic review and meta-analysis analysed the relationship between dietary protein and bone health across the life-course. The PubMed database was searched for all relevant human studies from the 1st January 1976 to 22nd January 2016, including all bone outcomes except calcium metabolism. The searches identified 127 papers for inclusion, including 74 correlational studies, 23 fracture or osteoporosis risk studies and 30 supplementation trials. Protein intake accounted for 0–4% of areal BMC and areal BMD variance in adults and 0–14% of areal BMC variance in children and adolescents. However, when confounder adjusted (5 studies) adult lumbar spine and femoral neck BMD associations were not statistically significant. There was no association between protein intake and relative risk (RR) of osteoporotic fractures for total (RR(random) = 0.94; 0.72 to 1.23, I2 = 32%), animal (RR (random) = 0.98; 0.76 to 1.27, I2 = 46%) or vegetable protein (RR (fixed) = 0.97 (0.89 to 1.09, I2 = 15%). In total protein supplementation studies, pooled effect sizes were not statistically significant for LSBMD (total n = 255, MD(fixed) = 0.04 g/cm2 (0.00 to 0.08, P = 0.07), I2 = 0%) or FNBMD (total n = 435, MD(random) = 0.01 g/cm2 (−0.03 to 0.05, P = 0.59), I2 = 68%). There appears to be little benefit of increasing protein intake for bone health in healthy adults but there is also clearly no indication of any detrimental effect, at least within the protein intakes of the populations studied (around 0.8–1.3 g/Kg/day). More studies are urgently required on the association between protein intake and bone health in children and adolescents.

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Acknowledgements

The authors are grateful to Dr. Helen Lambert for her help with translation of papers.

Awards

ALD received a Young Investigator Travel Award from the 10th International Symposium on the Nutritional Aspects of Osteoporosis Conference in Hong Kong, 28th November to 1st December 2017 for this work.

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Authors and Affiliations

  1. Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK

    A. L. Darling, R. J. F. Manders, D. J. Millward & S. A. Lanham-New

  2. Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, 1200 Centre St, Boston, MA, 02131, USA

    S. Sahni

  3. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    S. Sahni

  4. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia

    K. Zhu & R. L. Prince

  5. Medical School, University of Western Australia, Crawley, Western Australia, Australia

    K. Zhu & R. L. Prince

  6. York Trials Unit, Department of Health Sciences, University of York, York, UK

    C. E. Hewitt

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SS has received institutional grants from Dairy Management Inc. and she serves as a member of the National Dairy Council’s Nutrition Research Scientific Advisory Committee. SLN has received consultancy fees from the following companies/organisations: National Dairy Council UK, Yoplait, Kelloggs, Danone, Nestle. All other authors have nothing to declare.

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Darling, A.L., Manders, R.J.F., Sahni, S. et al. Dietary protein and bone health across the life-course: an updated systematic review and meta-analysis over 40 years. Osteoporos Int 30, 741–761 (2019). https://doi.org/10.1007/s00198-019-04933-8

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