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Dietary acid load, kidney function, osteoporosis, and risk of fractures in elderly men and women

Osteoporosis International volume 26, pages 563–570 (2015)Cite this article

Abstract

Summary

Because kidney dysfunction reduces the ability to excrete dietary acid excess, we hypothesized that underlying kidney function may have confounded the mixed studies linking dietary acid load with the risk of osteoporosis and fractures in the community. In a relatively large survey of elderly men and women, we report that dietary acid load did neither associate with DEXA-estimated bone mineral density nor with fracture risk. Underlying kidney function did not modify these null findings. Our results do not support the dietary acid-base hypothesis of bone loss.

Introduction

Impaired renal function reduces the ability to excrete dietary acid excess. We here investigate the association between dietary acid load and bone mineral density (BMD), osteoporosis, and fracture risk by renal function status.

Methods

An observational study was conducted in 861 community-dwelling 70-year-old men and women (49 % men) with complete dietary data from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS). The exposure was dietary acid load as estimated from 7-day food records by the net endogenous acid production (NEAP) and potential renal acid load (PRAL) algorithms. Renal function assessed by cystatin C estimated glomerular filtration rate was reduced in 21 % of the individuals. Study outcomes were BMD and osteoporosis state (assessed by DEXA) and time to fracture (median follow-up of 9.2 years).

Results

In cross-section, dietary acid load had no significant associations with BMD or with the diagnosis of osteoporosis. During follow-up, 131 fractures were validated. Neither NEAP (adjusted hazard ratios (HR) (95 % confidence interval (CI)), 1.01 (0.85–1.21), per 1 SD increment) nor PRAL (adjusted HR (95 % CI), 1.07 (0.88–1.30), per 1 SD increment) associated with fracture risk. Further multivariate adjustment for kidney function or stratification by the presence of kidney disease did not modify these null associations.

Conclusions

The hypothesis that dietary acid load associates with reduced BMD or increased fracture risk was not supported by this study in community-dwelling elderly individuals. Renal function did not influence on this null finding.

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Acknowledgments

This work was supported by the grants from the Swedish Research Council. Baxter Novum is the result of a grant from Baxter Healthcare Corporation to Karolinska Institutet.

Conflicts of interest

BL is affiliated with Baxter Healthcare Corporation. TEL is an employee of Astellas. Ting Jia, Liisa Byberg, Lars Lind, Karl Michaëlsson, and Juan Jesus Carrero declare that they have no conflict of interest.

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Authors and Affiliations

  1. Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

    T. Jia, B. Lindholm, T. E. Larsson & J. J. Carrero

  2. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

    T. Jia

  3. Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden

    L. Byberg & K. Michaëlsson

  4. Department of Medical Sciences, Acute and Internal Medicine, Uppsala University, Uppsala, Sweden

    L. Lind

  5. Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden

    J. J. Carrero

  6. Divisions of Renal Medicine and Baxter Novum, Karolinska University Hospital, Huddinge M99, Karolinska Institutet, SE-14186, Stockholm, Sweden

    J. J. Carrero

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  1. T. Jia
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Correspondence to J. J. Carrero.

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Jia, T., Byberg, L., Lindholm, B. et al. Dietary acid load, kidney function, osteoporosis, and risk of fractures in elderly men and women. Osteoporos Int 26, 563–570 (2015). https://doi.org/10.1007/s00198-014-2888-x

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  • DOI: https://doi.org/10.1007/s00198-014-2888-x

Keywords

  • Bone mineral density
  • Dietary acid load
  • Fractures
  • Osteoporosis
  • Renal function