Treating Osteoporosis

You may have heard that a diet low in calcium-rich foods, such as dairy products, causes osteoporosis, but research suggests that both high and low-protein diets may be even more important factors. Furthermore, a calcium-rich diet neither prevents (1) nor reverses osteoporosis enough to prevent bone fractures (1a). A report from the University of Connecticut showed that a low-protein diet can weaken bones by reducing absorption of calcium from your intestines (2). Several previous reports have shown that a high-protein diet may weaken bones (3,4,5,6). When you take in more protein than your body needs, your liver breaks down the extra protein building blocks, called amino acids, into organic acids that acidify your bloodstream, causing your kidneys to neutralize the acidity by pushing calcium out through your kidneys. Drinking several carbonated beverages each day (7) or eating large amounts of salt may also leach calcium from bones (8).

Drugs such as alendronate (brand name Fosamax) may help to prevent and treat osteoporosis(9). However, the bisphosphonates also weaken bones by delaying the normal restructuring of bones that goes on all the time. Therefore, current recommendations are that a person should not take bisphosphonates for more than three years or they may be increasing risk for fractures.

1) DJ Hosking, PD Ross, DE Thompson, RD Wasnich, M Mcclung, NH Bjarnason, P Ravn, G Cizza, M Daley, AJ Yates. Evidence that increased calcium intake does not prevent early postmenopausal bone loss. Clinical Therapeutics 20: 5 (SEP-OCT 1998):933-944.

1a) Feskanich D et al. American Journal of Public Health June, 1997.

2) JE Kerstetter, KO Obrien, KL Insogna. Dietary protein affects intestinal calcium absorption. American Journal of Clinical Nutrition 68: 4(OCT 1998):859-865.

3) NEJM, 1994(June 23);330:1776-1781.

4) American J of Clinical Nutrition 1994;59(Suppl):1238S-41S.

5) SJ Whiting, DJ Anderson, SJ Weeks. Calciuric effects of protein and potassium bicarbonate but not of sodium chloride or phosphate can be detected acutely in adult women and men. American Journal of Clinical Nutrition 65: 5(MAY 1997):1465-1472.

6) R Itoh, N Nishiyama, Y Suyama. Dietary protein intake and urinary excretion of calcium: a cross-sectional study in a healthy Japanese population. American Journal of Clinical Nutrition 67: 3(MAR 1998):438-444.

7) G Wyshak, RE Frisch. Carbonated Beverages, Dietary Calcium, and Dietary Calcium/ Phosphorus Ratio, and Bone Fractures in Girls and Boys. Journal of Adolescent Health 1994(May);15(3):210-215.

8) G Jones, T Beard, V Parameswaran, T Greenaway, R Vonwitt. A population-based study of the relationship between salt intake, bone resorption and bone mass. European Journal of Clinical Nutrition 51: 8(AUG 1997):561-565.

9) M Mcclung, B Clemmesen, A Daifotis, NL Gilchrist, J Eisman, RS Weinstein, GE Fuleihan, C Reda, AJ Yates, P Ravn. Alendronate prevents postmenopausal bone loss in women without osteoporosis - A double-blind, randomized, controlled trial. Annals of Internal Medicine 128: 4 (FEB 15 1998):253.

10) Schneider DL, Barrett-Connor E, Morton DJ. Timing of postmenopausal estrogen for optimal bone mineral density. JAMA 1997(Feb 19);277(7):543-547.

11) SL Greenspan, S Holland, L Maitlandramsey, M Poku, A Freeman, WY Yuan, U Kher, B Gertz. Alendronate stimulation of nocturnal parathyroid hormone secretion: A mechanism to explain the continued improvement in bone mineral density accompanying alendronate therapy. Proceedings of the Association of American Physicians. 108: 3 (MAY 1996):230-238.

12) T Saarto, C Blomqvist, M Valimaki, P Makela, S Sarna, I Elomaa. Clodronate improves bone mineral density in postmenopausal breast cancer patients treated with adjuvant antioestrogens. British Journal of Cancer 75: 4 (1997):602-605.

13) L Flicker, JL Hopper, RG Larkins, M Lichtenstein, G Buirski, JD Wark. Nandrolone decanoate and intranasal calcitonin as therapy in established osteoporosis. Osteoporosis International 7: 1 (1997):29-35.

14) D Feskanich, WC Willett, MJ Stampfer, GA Colditz. A prospective study of thiazide use and fractures in women. Osteoporosis International 7: 1 (1997):79-84.

Checked 3/11/14

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