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The interaction between dietary protein and bone health

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Abstract

The role of dietary protein in bone health has been controversial. On the one hand, a plentiful supply of dietary amino acids has been considered important to support bone remodeling while on the other hand there have been concerns that the dietary acid load associated with protein consumption promotes hypercalciuria and loss of bone calcium stores. This article reviews the effect of dietary protein on bone mass and bone density, and the effect on markers of bone resorption and formation and also on fracture risk, looking at both cross-sectional and longitudinal studies and examining both meat and vegetable protein including soy and milk basic protein. The results are not entirely consistent and suggest that the interaction between dietary protein and other components in a mixed diet, such as calcium intake and vegetables and fruit to neutralize acid, are important and may determine whether high-protein diets are beneficial to bone health. Overall the results suggest that dietary protein has a modest beneficial effect on bone markers and bone density. This effect has yet to be consistently linked to reduced fracture risk, probably because of the role of other etiological factors such as the risk of falls. There is not enough evidence currently to suggest that animal protein is superior or inferior to vegetable protein, or that milk or soy protein, respectively, is more favorable than other protein sources.

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References

  1. Clemmons DR, Seek MM, Underwood LE (1985) Supplemental essential amino acids augment the somatomedin-C/insulin-like growth factor I response to refeeding after fasting. Metabolism 34:391–395

    Article  CAS  PubMed  Google Scholar 

  2. Beasley JM, Ichikawa LE, Ange BA, Spangler L, LaCroix AZ, Ott SM, Scholes D (2010) Is protein intake associated with bone mineral density in young women? Am J Clin Nutr 91:1311–1316

    Google Scholar 

  3. Cooper C, Atkinson EJ, Hensrud DD, Wahner HW, O’Fallon WM, Riggs BL, Melton LJ 3rd (1996) Dietary protein intake and bone mass in women. Calcif Tissue Int 58:320–325

    CAS  PubMed  Google Scholar 

  4. Lacey JM, Anderson JJ, Fujita T, Yoshimoto Y, Fukase M, Tsuchie S, Koch GG (1991) Correlates of cortical bone mass among premenopausal and postmenopausal Japanese women. J Bone Miner Res 6:651–659

    Article  CAS  PubMed  Google Scholar 

  5. Michaelsson K, Holmberg L, Mallmin H, Wolk A, Bergstrom R, Ljunghall S (1995) Diet, bone mass, and osteocalcin: a cross-sectional study. Calcif Tissue Int 57:86–93

    Article  CAS  PubMed  Google Scholar 

  6. Teegarden D, Lyle RM, McCabe GP, McCabe LD, Proulx WR, Michon K, Knight AP, Johnston CC, Weaver CM (1998) Dietary calcium, protein, and phosphorus are related to bone mineral density and content in young women. Am J Clin Nutr 68:749–754

    CAS  PubMed  Google Scholar 

  7. Chiu JF, Lan SJ, Yang CY, Wang PW, Yao WJ, Su LH, Hsieh CC (1997) Long-term vegetarian diet and bone mineral density in postmenopausal Taiwanese women. Calcif Tissue Int 60:245–249

    Article  CAS  PubMed  Google Scholar 

  8. Ilich JZ, Brownbill RA, Tamborini L (2003) Bone and nutrition in elderly women: protein, energy, and calcium as main determinants of bone mineral density. Eur J Clin Nutr 57:554–565

    Article  CAS  PubMed  Google Scholar 

  9. Rapuri PB, Gallagher JC, Haynatzka V (2003) Protein intake: effects on bone mineral density and the rate of bone loss in elderly women. Am J Clin Nutr 77:1517–1525

    CAS  PubMed  Google Scholar 

  10. Jaime PC, Latorre Mdo R, Florindo AA, Tanaka T, Zerbini CA (2006) Dietary intake of Brazilian black and white men and its relationship to the bone mineral density of the femoral neck. Sao Paulo Med J 124:267–270

    Article  PubMed  Google Scholar 

  11. Kyriazopoulos P, Trovas G, Charopoulos J, Antonogiannakis E, Galanos A, Lyritis G (2006) Lifestyle factors and forearm bone density in young Greek men. Clin Endocrinol (Oxf) 65:234–238

    Article  CAS  Google Scholar 

  12. Whiting SJ, Boyle JL, Thompson A, Mirwald RL, Faulkner RA (2002) Dietary protein, phosphorus and potassium are beneficial to bone mineral density in adult men consuming adequate dietary calcium. J Am Coll Nutr 21:402–409

    CAS  PubMed  Google Scholar 

  13. Vatanparast H, Bailey DA, Baxter-Jones AD, Whiting SJ (2007) The effects of dietary protein on bone mineral mass in young adults may be modulated by adolescent calcium intake. J Nutr 137:2674–2679

    CAS  PubMed  Google Scholar 

  14. Geinoz G, Rapin CH, Rizzoli R, Kraemer R, Buchs B, Slosman D, Michel JP, Bonjour JP (1993) Relationship between bone mineral density and dietary intakes in the elderly. Osteoporos Int 3:242–248

    Article  CAS  PubMed  Google Scholar 

  15. Hannan MT, Tucker KL, Dawson-Hughes B, Cupples LA, Felson DT, Kiel DP (2000) Effect of dietary protein on bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res 15:2504–2512

    Article  CAS  PubMed  Google Scholar 

  16. Promislow JH, Goodman-Gruen D, Slymen DJ, Barrett-Connor E (2002) Protein consumption and bone mineral density in the elderly: the Rancho Bernardo Study. Am J Epidemiol 155:636–644

    Article  PubMed  Google Scholar 

  17. Tucker KL, Hannan MT, Kiel DP (2001) The acid-base hypothesis: diet and bone in the Framingham Osteoporosis Study. Eur J Nutr 40:231–237

    Article  CAS  PubMed  Google Scholar 

  18. Schurch MA, Rizzoli R, Slosman D, Vadas L, Vergnaud P, Bonjour JP (1998) Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 128:801–809

    CAS  PubMed  Google Scholar 

  19. Darling AL, Millward DJ, Torgerson DJ, Hewitt CE, Lanham-New SA (2009) Dietary protein and bone health: a systematic review and meta-analysis. Am J Clin Nutr 90:1674–1692

    Article  CAS  PubMed  Google Scholar 

  20. Gaffney-Stomberg E, Insogna KL, Rodriguez NR, Kerstetter JE (2009) Increasing dietary protein requirements in elderly people for optimal muscle and bone health. J Am Geriatr Soc 57:1073–1079

    Article  PubMed  Google Scholar 

  21. Wengreen HJ, Munger RG, West NA, Cutler DR, Corcoran CD, Zhang J, Sassano NE (2004) Dietary protein intake and risk of osteoporotic hip fracture in elderly residents of Utah. J Bone Miner Res 19:537–545

    Article  PubMed  Google Scholar 

  22. Feskanich D, Willett WC, Stampfer MJ, Colditz GA (1996) Protein consumption and bone fractures in women. Am J Epidemiol 143:472–479

    CAS  PubMed  Google Scholar 

  23. Meyer HE, Pedersen JI, Loken EB, Tverdal A (1997) Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Am J Epidemiol 145:117–123

    CAS  PubMed  Google Scholar 

  24. Munger RG, Cerhan JR, Chiu BC (1999) Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women. Am J Clin Nutr 69:147–152

    CAS  PubMed  Google Scholar 

  25. Thorpe DL, Knutsen SF, Beeson WL, Rajaram S, Fraser GE (2008) Effects of meat consumption and vegetarian diet on risk of wrist fracture over 25 years in a cohort of peri- and postmenopausal women. Public Health Nutr 11:564–572

    Article  PubMed  Google Scholar 

  26. Zhang X, Shu XO, Li H, Yang G, Li Q, Gao YT, Zheng W (2005) Prospective cohort study of soy food consumption and risk of bone fracture among postmenopausal women. Arch Intern Med 165:1890–1895

    Article  PubMed  Google Scholar 

  27. Mussolino ME, Looker AC, Madans JH, Langlois JA, Orwoll ES (1998) Risk factors for hip fracture in white men: the NHANES I Epidemiologic Follow-up Study. J Bone Miner Res 13:918–924

    Article  CAS  PubMed  Google Scholar 

  28. Wachman A, Bernstein DS (1968) Diet and osteoporosis. Lancet 1:958–959

    Article  CAS  PubMed  Google Scholar 

  29. Sebastian A, Harris ST, Ottaway JH, Todd KM, Morris RC Jr (1994) Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. N Engl J Med 330:1776–1781

    Article  CAS  PubMed  Google Scholar 

  30. Marangella M, Di Stefano M, Casalis S, Berutti S, D’Amelio P, Isaia GC (2004) Effects of potassium citrate supplementation on bone metabolism. Calcif Tissue Int 74:330–335

    Article  CAS  PubMed  Google Scholar 

  31. Thorpe M, Mojtahedi MC, Chapman-Novakofski K, McAuley E, Evans EM (2008) A positive association of lumbar spine bone mineral density with dietary protein is suppressed by a negative association with protein sulfur. J Nutr 138:80–85

    CAS  PubMed  Google Scholar 

  32. Ince BA, Anderson EJ, Neer RM (2004) Lowering dietary protein to U.S. Recommended dietary allowance levels reduces urinary calcium excretion and bone resorption in young women. J Clin Endocrinol Metab 89:3801–3807

    Article  CAS  PubMed  Google Scholar 

  33. Alexy U, Remer T, Manz F, Neu CM, Schoenau E (2005) Long-term protein intake and dietary potential renal acid load are associated with bone modeling and remodeling at the proximal radius in healthy children. Am J Clin Nutr 82:1107–1114

    CAS  PubMed  Google Scholar 

  34. Sebastian A (2005) Dietary protein content and the diet’s net acid load: opposing effects on bone health. Am J Clin Nutr 82:921–922

    CAS  PubMed  Google Scholar 

  35. Heaney RP, Layman DK (2008) Amount and type of protein influences bone health. Am J Clin Nutr 87:1567S–1570S

    CAS  PubMed  Google Scholar 

  36. Dawson-Hughes B, Harris SS (2002) Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Am J Clin Nutr 75:773–779

    CAS  PubMed  Google Scholar 

  37. New SA, Millward DJ (2003) Calcium, protein, and fruit and vegetables as dietary determinants of bone health. Am J Clin Nutr 77:1340–1341; author reply 1341

    CAS  PubMed  Google Scholar 

  38. Kerstetter JE, O’Brien KO, Caseria DM, Wall DE, Insogna KL (2005) The impact of dietary protein on calcium absorption and kinetic measures of bone turnover in women. J Clin Endocrinol Metab 90:26–31

    Article  CAS  PubMed  Google Scholar 

  39. Lopez-Gonzalez AA, Grases F, Roca P, Mari B, Vicente-Herrero MT, Costa-Bauza A (2008) Phytate (myo-inositol hexaphosphate) and risk factors for osteoporosis. J Med Food 11:747–752

    Article  CAS  PubMed  Google Scholar 

  40. Alekel DL, Germain AS, Peterson CT, Hanson KB, Stewart JW, Toda T (2000) Isoflavone-rich soy protein isolate attenuates bone loss in the lumbar spine of perimenopausal women. Am J Clin Nutr 72:844–852

    CAS  PubMed  Google Scholar 

  41. Arjmandi BH, Khalil DA, Smith BJ, Lucas EA, Juma S, Payton ME, Wild RA (2003) Soy protein has a greater effect on bone in postmenopausal women not on hormone replacement therapy, as evidenced by reducing bone resorption and urinary calcium excretion. J Clin Endocrinol Metab 88:1048–1054

    Article  CAS  PubMed  Google Scholar 

  42. Arjmandi BH, Lucas EA, Khalil DA, Devareddy L, Smith BJ, McDonald J, Arquitt AB, Payton ME, Mason C (2005) One year soy protein supplementation has positive effects on bone formation markers but not bone density in postmenopausal women. Nutr J 4:8

    Article  PubMed  Google Scholar 

  43. Dalais FS, Ebeling PR, Kotsopoulos D, McGrath BP, Teede HJ (2003) The effects of soy protein containing isoflavones on lipids and indices of bone resorption in postmenopausal women. Clin Endocrinol (Oxf) 58:704–709

    Article  CAS  Google Scholar 

  44. Evans EM, Racette SB, Van Pelt RE, Peterson LR, Villareal DT (2007) Effects of soy protein isolate and moderate exercise on bone turnover and bone mineral density in postmenopausal women. Menopause 14:481–488

    Article  PubMed  Google Scholar 

  45. Gallagher JC, Satpathy R, Rafferty K, Haynatzka V (2004) The effect of soy protein isolate on bone metabolism. Menopause 11:290–298

    Article  PubMed  Google Scholar 

  46. Ho SC, Woo J, Lam S, Chen Y, Sham A, Lau J (2003) Soy protein consumption and bone mass in early postmenopausal Chinese women. Osteoporos Int 14:835–842

    Article  CAS  PubMed  Google Scholar 

  47. Horiuchi T, Onouchi T, Takahashi M, Ito H, Orimo H (2000) Effect of soy protein on bone metabolism in postmenopausal Japanese women. Osteoporos Int 11:721–724

    Article  CAS  PubMed  Google Scholar 

  48. Khalil DA, Lucas EA, Juma S, Smith BJ, Payton ME, Arjmandi BH (2002) Soy protein supplementation increases serum insulin-like growth factor-I in young and old men but does not affect markers of bone metabolism. J Nutr 132:2605–2608

    CAS  PubMed  Google Scholar 

  49. Kreijkamp-Kaspers S, Kok L, Grobbee DE, de Haan EH, Aleman A, Lampe JW, van der Schouw YT (2004) Effect of soy protein containing isoflavones on cognitive function, bone mineral density, and plasma lipids in postmenopausal women: a randomized controlled trial. JAMA 292:65–74

    Article  CAS  PubMed  Google Scholar 

  50. Newton KM, LaCroix AZ, Levy L, Li SS, Qu P, Potter JD, Lampe JW (2006) Soy protein and bone mineral density in older men and women: a randomized trial. Maturitas 55:270–277

    Article  CAS  PubMed  Google Scholar 

  51. Potter SM, Baum JA, Teng H, Stillman RJ, Shay NF, Erdman JW Jr (1998) Soy protein and isoflavones: their effects on blood lipids and bone density in postmenopausal women. Am J Clin Nutr 68:1375S–1379S

    CAS  PubMed  Google Scholar 

  52. Roughead ZK, Hunt JR, Johnson LK, Badger TM, Lykken GI (2005) Controlled substitution of soy protein for meat protein: effects on calcium retention, bone, and cardiovascular health indices in postmenopausal women. J Clin Endocrinol Metab 90:181–189

    Article  CAS  PubMed  Google Scholar 

  53. Vupadhyayula PM, Gallagher JC, Templin T, Logsdon SM, Smith LM (2009) Effects of soy protein isolate on bone mineral density and physical performance indices in postmenopausal women: a 2-year randomized, double-blind, placebo-controlled trial. Menopause 16:320–328

    Article  PubMed  Google Scholar 

  54. Budek AZ, Hoppe C, Ingstrup H, Michaelsen KF, Bugel S, Molgaard C (2007) Dietary protein intake and bone mineral content in adolescents: The Copenhagen Cohort Study. Osteoporos Int 18:1661–1667

    Article  CAS  PubMed  Google Scholar 

  55. Aoe S, Koyama T, Toba Y, Itabashi A, Takada Y (2005) A controlled trial of the effect of milk basic protein (MBP) supplementation on bone metabolism in healthy menopausal women. Osteoporos Int 16:2123–2128

    Article  CAS  PubMed  Google Scholar 

  56. Aoe S, Toba Y, Yamamura J, Kawakami H, Yahiro M, Kumegawa M, Itabashi A, Takada Y (2001) Controlled trial of the effects of milk basic protein (MBP) supplementation on bone metabolism in healthy adult women. Biosci Biotechnol Biochem 65:913–918

    Article  CAS  PubMed  Google Scholar 

  57. Toba Y, Takada Y, Matsuoka Y, Morita Y, Motouri M, Hirai T, Suguri T, Aoe S, Kawakami H, Kumegawa M, Takeuchi A, Itabashi A (2001) Milk basic protein promotes bone formation and suppresses bone resorption in healthy adult men. Biosci Biotechnol Biochem 65:1353–1357

    Article  CAS  PubMed  Google Scholar 

  58. Uenishi K, Ishida H, Toba Y, Aoe S, Itabashi A, Takada Y (2007) Milk basic protein increases bone mineral density and improves bone metabolism in healthy young women. Osteoporos Int 18:385–390

    Article  CAS  PubMed  Google Scholar 

  59. Yamamura J, Aoe S, Toba Y, Motouri M, Kawakami H, Kumegawa M, Itabashi A, Takada Y (2002) Milk basic protein (MBP) increases radial bone mineral density in healthy adult women. Biosci Biotechnol Biochem 66:702–704

    Article  CAS  PubMed  Google Scholar 

  60. Zou ZY, Lin XM, Xu XR, Xu R, Ma L, Li Y, Wang MF (2009) Evaluation of milk basic protein supplementation on bone density and bone metabolism in Chinese young women. Eur J Nutr 48:301–306

    Article  CAS  PubMed  Google Scholar 

  61. Frassetto LA, Todd KM, Morris RC Jr, Sebastian A (2000) Worldwide incidence of hip fracture in elderly women: relation to consumption of animal and vegetable foods. J Gerontol A Biol Sci Med Sci 55:M585–M592

    CAS  PubMed  Google Scholar 

  62. Weikert C, Walter D, Hoffmann K, Kroke A, Bergmann MM, Boeing H (2005) The relation between dietary protein, calcium and bone health in women: results from the EPIC-Potsdam cohort. Ann Nutr Metab 49:312–318

    Article  CAS  PubMed  Google Scholar 

  63. Sellmeyer DE, Stone KL, Sebastian A, Cummings SR (2001) A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Study of Osteoporotic Fractures Research Group. Am J Clin Nutr 73:118–122

    CAS  PubMed  Google Scholar 

  64. Sebastian A, Sellmeyer DE, Stone KL, Cummings SR (2001) Dietary ratio of animal to vegetable protein and rate of bone loss and risk of fracture in postmenopausal women. Am J Clin Nutr 74:411–412

    CAS  PubMed  Google Scholar 

  65. Roughead ZK, Johnson LK, Lykken GI, Hunt JR (2003) Controlled high meat diets do not affect calcium retention or indices of bone status in healthy postmenopausal women. J Nutr 133:1020–1026

    CAS  PubMed  Google Scholar 

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  1. Food and Nutritional Sciences, Commonwealth Scientific and Industrial Research Organisation (CSIRO), PO Box 10041, Adelaide, BC, SA, 5000, Australia

    David Jesudason & Peter Clifton

  2. Department of Medicine, University of Adelaide, Adelaide, Australia

    David Jesudason & Peter Clifton

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  1. David Jesudason
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Correspondence to David Jesudason.

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Jesudason, D., Clifton, P. The interaction between dietary protein and bone health. J Bone Miner Metab 29, 1–14 (2011). https://doi.org/10.1007/s00774-010-0225-9

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