The present cross-sectional study performed using data from the Korea National Health and Nutrition Examination Survey in 9526 women older than 18 years of age demonstrates that high sodium intake is associated with lower bone mineral density and sodium intake ≥2000 mg/day is a risk factor for osteoporosis in postmenopausal women.
Several studies have reported that large amount of dietary sodium intake is highly associated with elevated urinary calcium. However, the direct effect of excessive dietary sodium intake on bone mass, as a risk factor for osteoporosis, is still a controversial issue. The aim of the present study was to assess the relationship between high intake of sodium and lower bone mass and risk of osteoporosis in adult women.
This cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey (KNHANES), 2008–2011. Participants (n = 9526 women older than 18 years) were divided into a premenopausal (n = 4793) and postmenopausal (n = 4733) group. Both groups were subdivided into five groups according to quintiles of energy-adjusted sodium intake. Multiple regression analysis was performed to assess relationships between sodium intake and lower bone mass.
Multivariate linear regression analysis showed that high sodium intake was negatively associated with bone mineral content (BMC) and bone mineral density (BMD) in postmenopausal women. After adjusting confounding factors, high sodium intake was negatively associated with BMC and BMD of the lumbar spine in postmenopausal women. Postmenopausal women, whose sodium intake was ≥2000 mg/day (odds ratio 1.284, 95% CI 1.029–1.603, P = 0.027), were at risk of developing osteoporosis after adjustment of confounding variables.
The present study suggested that high sodium intake could be a potential risk factor for low bone mass after adjusting for confounding factors in postmenopausal women.
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Klibanski A, Adams-Campbell L, Bassford T et al (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795
Park EJ, Joo IW, Jang MJ, Kim YT, Oh K, Oh HJ (2014) Prevalence of osteoporosis in the Korean population based on Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2011. Yonsei Med J 55:1049–1057
Bonjour JP, Gueguen L, Palacios C, Shearer MJ, Weaver CM (2009) Minerals and vitamins in bone health: the potential value of dietary enhancement. Brit J Nutr 101:1581–1596
Heaney RP (2007) Bone health. Am J Clin Nutr 85:300s–303s
Teucher B, Fairweather-Tait S (2003) Dietary sodium as a risk factor for osteoporosis: where is the evidence? Proc Nutr Soc 62:859–866
Shortt C, Flynn A (1990) Sodium-calcium inter-relationships with specific reference to osteoporosis. Nutr Res Rev 3:101–115
Breslau NA, McGuire JL, Zerwekh JE, Pak CY (1982) The role of dietary sodium on renal excretion and intestinal absorption of calcium and on vitamin D metabolism. J Clin Endocrinol Metab 55:369–373
Zarkadas M, Gougeon-Reyburn R, Marliss EB, Block E, Alton-Mackey M (1989) Sodium chloride supplementation and urinary calcium excretion in postmenopausal women. Am J Clin Nutr 50:1088–1094
Ross PD, Knowlton W (1998) Rapid bone loss is associated with increased levels of biochemical markers. J Bone Miner Res 13:297–302
Garnero P, Sornay-Rendu E, Claustrat B, Delmas PD (2000) Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY study. J Bone Miner Res 15:1526–1536
Park SM, Joung JY, Cho YY, Sohn SY, Hur KY, Kim JH, Kim SW, Chung JH, Lee MK, Min YK (2015) Effect of high dietary sodium on bone turnover markers and urinary calcium excretion in Korean postmenopausal women with low bone mass. Eur J Clin Nutr 69:361–366
Lin PH, Ginty F, Appel LJ, Aickin M, Bohannon A, Garnero P, Barclay D, Svetkey LP (2003) The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults. J Nutr 133:3130–3136
Evans CE, Chughtai AY, Blumsohn A, Giles M, Eastell R (1997) The effect of dietary sodium on calcium metabolism in premenopausal and postmenopausal women. Eur J Clin Nutr 51:394–399
Chan AYS, Poon P, Chan ELP, Fung SLM, Swaminathan R (1993) The effect of high sodium-intake on bone-mineral content in rats fed a normal calcium or a low-calcium diet. Osteoporosis Int 3:341–344
Devine A, Criddle RA, Dick IM, Kerr DA, Prince RL (1995) A longitudinal-study of the effect of sodium and calcium intakes on regional bone-density in postmenopausal women. Am J Clin Nutr 62:740–745
Greendale GA, Barrettconnor E, Edelstein S, Ingles S, Haile R (1994) Dietary-sodium and bone-mineral density—results of a 16-year follow-up-study. J Am Geriatr Soc 42:1050–1055
Ilich JZ, Brownbill RA, Coster DC (2010) Higher habitual sodium intake is not detrimental for bones in older women with adequate calcium intake. Eur J Appl Physiol 109:745–755
Carbone L, Johnson KC, Huang Y et al (2016) Sodium intake and osteoporosis. Findings From the Women's Health Initiative J Clin Endocrinol Metab 101:1414–1421
The Division of Chronic Disease Surveillance, Korea Centers for Disease Control and Prevention (2008–2011) The fourth and fifth Korea National Health and Nutrition Examination Survey (KNHANES IV & V)
Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, Chun C, Khang YH, Oh K (2014) Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol 43:69–77
Rural Resource Development Institute (2006) Food composition table, 7th edn. Suwon, Korea
World Health Organization (2012) WHO guideline: sodium intake for adults and children. World Health Organization, Geneva
Kim JE, Lee YH, Huh JH, Kang DR, Rhee Y, Lim SK (2014) Early-stage chronic kidney disease, insulin resistance, and osteoporosis as risk factors of sarcopenia in aged population: the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV), 2008-2009. Osteoporosis Int 25:2189–2198
Lee KS, Bae SH, Lee SH, Lee J, Lee DR (2014) New reference data on bone mineral density and the prevalence of osteoporosis in Korean adults aged 50 years or older: the Korea National Health and Nutrition Examination Survey 2008-2010. J Korean Med Sci 29:1514–1522
Genant HK, Cooper C, Poor G et al (1999) Interim report and recommendations of the World Health Organization task-force for osteoporosis. Osteoporos Int 10:259–264
Saylor J, Friedmann E, Lee HJ (2012) Navigating complex sample analysis using national survey data. Nurs Res 61:231–237
Willett WC, Howe GR, Kushi LH (1997) Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 65:1220S–1228S
Greenland S, Pearce N (2015) Statistical foundations for model-based adjustments. Annu Rev Publ Health 36:89–108
Powles J, Fahimi S, Micha R, Khatibzadeh S, Shi P, Ezzati M, Engell RE, Lim SS, Danaei G, Mozaffarian D (2013) Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ 3(12):e003733
Kim SW, Jeon JH, Choi YK, Lee WK, Hwang IR, Kim JG, Lee IK, Park KG (2015) Association of urinary sodium/creatinine ratio with bone mineral density in postmenopausal women: KNHANES 2008-2011. Endocrine 49:791–799
Park Y, Kwon SJ, Ha YC (2016) Association between urinary sodium excretion and bone health in male and female adults. Ann Nutr Metab 68:189–196
Eastell R, Mosekilde L, Hodgson SF, Riggs BL (1990) Proportion of human vertebral body bone that is cancellous. J Bone Miner Res 5:1237–1241
Werner C, Iversen BF, Therkildsen MH (1988) Contribution of the trabecular component to mechanical strength and bone mineral content of the femoral neck. An experimental study on cadaver bones. Scand J Clin Lab Invest 48:457–460
The Korean Nutrition Society (2010) Dietary reference intakes for Koreans. Hanareum, Seoul, pp 337–401
Bedford JL, Barr SI (2011) Higher urinary sodium, a proxy for intake, is associated with increased calcium excretion and lower hip bone density in healthy young women with lower calcium intakes. Nutrients 3:951–961
Carbone LD, Bush AJ, Barrow KD, Kang AH (2003) The relationship of sodium intake to calcium and sodium excretion and bone mineral density of the hip in postmenopausal African-American and Caucasian women. J Bone Miner Metab 21:415–420
Heaney RP (2006) Role of dietary sodium in osteoporosis. J Am Coll Nutr 25:271–276
Shin D, Joh HK, Kim KH, Park SM (2013) Benefits of potassium intake on metabolic syndrome: the fourth Korean National Health and Nutrition Examination Survey (KNHANES IV). Atherosclerosis 230:80–85
This work was supported by the Korea Research Foundation (2015R1D1A1A09060823) funded by the Korean Government.
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Kwon, SJ., Ha, YC. & Park, Y. High dietary sodium intake is associated with low bone mass in postmenopausal women: Korea National Health and Nutrition Examination Survey, 2008–2011. Osteoporos Int 28, 1445–1452 (2017). https://doi.org/10.1007/s00198-017-3904-8
- Bone mass
- Bone mineral density
- Sodium intake