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    Frassetto, Lynda A. and Sebastian, Anthony 2013. Commentary to accompany the paper entitled ‘Nutritional disturbance in acid–base balance and osteoporosis: a hypothesis that disregards the essential homeostatic role of the kidney’, by Jean-Philippe Bonjour. British Journal of Nutrition, Vol. 110, Issue. 11, p. 1935.


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Nutritional disturbance in acid–base balance and osteoporosis: a hypothesis that disregards the essential homeostatic role of the kidney

  • Jean-Philippe Bonjour (a1)
  • DOI: http://dx.doi.org/10.1017/S0007114513000962
  • Published online: 04 April 2013
Abstract

The nutritional acid load hypothesis of osteoporosis is reviewed from its historical origin to most recent studies with particular attention to the essential but overlooked role of the kidney in acid–base homeostasis. This hypothesis posits that foods associated with an increased urinary acid excretion are deleterious for the skeleton, leading to osteoporosis and enhanced fragility fracture risk. Conversely, foods generating neutral or alkaline urine would favour bone growth and Ca balance, prevent bone loss and reduce osteoporotic fracture risk. This theory currently influences nutrition research, dietary recommendations and the marketing of alkaline salt products or medications meant to optimise bone health and prevent osteoporosis. It stemmed from classic investigations in patients suffering from chronic kidney diseases (CKD) conducted in the 1960s. Accordingly, in CKD, bone mineral mobilisation would serve as a buffer system to acid accumulation. This interpretation was later questioned on both theoretical and experimental grounds. Notwithstanding this questionable role of bone mineral in systemic acid–base equilibrium, not only in CKD but even more in the absence of renal impairment, it is postulated that, in healthy individuals, foods, particularly those containing animal protein, would induce ‘latent’ acidosis and result, in the long run, in osteoporosis. Thus, a questionable interpretation of data from patients with CKD and the subsequent extrapolation to healthy subjects converted a hypothesis into nutritional recommendations for the prevention of osteoporosis. In a historical perspective, the present review dissects out speculation from experimental facts and emphasises the essential role of the renal tubule in systemic acid–base and Ca homeostasis.

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Copyright
The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence <http://creativecommons.org/licenses/by/3.0/>.
Corresponding author
*Corresponding author: Dr Jean-Philippe Bonjour, fax +41 22 38 29 973, email jean-philippe.bonjour@unige.ch
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

7J Vormann & T Goedecke (2006) Acid–base homeostasis: latent acidosis as a cause of chronic diseases. Swiss J Integr Med 18, 255266.

9TR Fenton , M Eliasziw , SC Tough , et al. (2010) Low urine pH and acid excretion do not predict bone fractures or the loss of bone mineral density: a prospective cohort study. BMC Musculoskelet Disord 11, 88.

10TR Fenton , SC Tough , AW Lyon , et al. (2011) Causal assessment of dietary acid load and bone disease: a systematic review & meta-analysis applying Hill's epidemiologic criteria for causality. Nutr J 10, 41.

11PA Stewart (1978) Independent and dependent variables of acid–base control. Respir Physiol 33, 926.

12PA Stewart (1983) Modern quantitative acid–base chemistry. Can J Physiol Pharmacol 61, 14441461.

13I Kurtz , J Kraut , V Ornekian , et al. (2008) Acid–base analysis: a critique of the Stewart and bicarbonate-centered approaches. Am J Physiol Renal Physiol 294, F1009F1031.

14AS Relman (1954) What are acids and bases? Am J Med 17, 435437.

17LL Hamm , RJ Alpern & PA Preisig (2008) Cellular mechanisms of renal tubular acidification. In Seldin and Giebisch's The Kidney, 4th ed. [RJ Alpern and SC Hebert , editors]. London: Academic Press.

18BM Koeppen (2009) The kidney and acid–base regulation. Adv Physiol Educ 33, 275281.

19ID Weiner & JW Verlander (2011) Role of NH3 and NH4+ transporters in renal acid–base transport. Am J Physiol Renal Physiol 300, F11F23.

21AS Relman , EJ Lennon & J Lemann Jr (1961) Endogenous production of fixed acid and the measurement of the net balance of acid in normal subjects. J Clin Invest 40, 16211630.

22AD Goodman , J Lemann Jr, EJ Lennon , et al. (1965) Production, excretion, and net balance of fixed acid in patients with renal acidosis. J Clin Invest 44, 495506.

23J Lemann Jr, JR Litzow & EJ Lennon (1966) The effects of chronic acid loads in normal man: further evidence for the participation of bone mineral in the defense against chronic metabolic acidosis. J Clin Invest 45, 16081614.

24JR Litzow , J Lemann Jr & EJ Lennon (1967) The effect of treatment of acidosis on calcium balance in patients with chronic azotemic renal disease. J Clin Invest 46, 280286.

26R Rizzoli & JP Bonjour (2006) Physiology of calcium and phosphate homeostasis. In Dynamics of Bone and Cartilage Metabolism: Principles and Clinical Applications, 2nd ed., pp. 345360 [MJ Seibel , SP Robins and JP Bilezikian , editors]. San Diego, CA: Academic Press.

29TR Fenton & AW Lyon (2011) Milk and acid–base balance: proposed hypothesis versus scientific evidence. J Am Coll Nutr 30, 471S475S.

30MS Oh (1991) Irrelevance of bone buffering to acid–base homeostasis in chronic metabolic acidosis. Nephron 59, 710.

31J Uribarri , H Douyon & MS Oh (1995) A re-evaluation of the urinary parameters of acid production and excretion in patients with chronic renal acidosis. Kidney Int 47, 624627.

32MS Oh & HJ Carroll (2008) External balance of electrolytes and acids and alkalis. In Seldin and Giebisch's The Kidney, 4th ed. [RJ Alpern and SC Hebert , editors]. London: Academic Press.

33MS Oh (2000) New perspectives on acid–base balance. Semin Dial 13, 212219.

34J Uribarri (2000) Acidosis in chronic renal insufficiency. Semin Dial 13, 232234.

36US Barzel (1969) The effect of excessive acid feeding on bone. Calcif Tissue Res 4, 94100.

37TR Arnett & DW Dempster (1986) Effect of pH on bone resorption by rat osteoclasts in vitro. Endocrinology 119, 119124.

38DA Bushinsky & KK Frick (2000) The effects of acid on bone. Curr Opin Nephrol Hypertens 9, 369379.

39DA Bushinsky , SB Smith , KL Gavrilov , et al. (2003) Chronic acidosis-induced alteration in bone bicarbonate and phosphate. Am J Physiol Renal Physiol 285, F532F539.

40KK Frick , NS Krieger , K Nehrke , et al. (2009) Metabolic acidosis increases intracellular calcium in bone cells through activation of the proton receptor OGR1. J Bone Miner Res 24, 305313.

41US Barzel (1995) The skeleton as an ion exchange system: implications for the role of acid–base imbalance in the genesis of osteoporosis. J Bone Miner Res 10, 14311436.

43E Wynn , MA Krieg , JM Aeschlimann , et al. (2009) Alkaline mineral water lowers bone resorption even in calcium sufficiency: alkaline mineral water and bone metabolism. Bone 44, 120124.

45D Feskanich , WC Willett , MJ Stampfer , et al. (1996) Protein consumption and bone fractures in women. Am J Epidemiol 143, 472479.

51JH Promislow , D Goodman-Gruen , DJ Slymen , et al. (2002) Protein consumption and bone mineral density in the elderly: The Rancho Bernardo Study. Am J Epidemiol 155, 636644.

52HJ Wengreen , RG Munger , NA West , et al. (2004) Dietary protein intake and risk of osteoporotic hip fracture in elderly residents of Utah. J Bone Miner Res 19, 537545.

53P Dargent-Molina , S Sabia , M Touvier , et al. (2008) Proteins, dietary acid load, and calcium and risk of postmenopausal fractures in the E3N French women prospective study. J Bone Miner Res 23, 19151922.

56D Misra , SD Berry , KE Broe , et al. (2011) Does dietary protein reduce hip fracture risk in elders? The Framingham Osteoporosis Study. Osteoporos Int 22, 345349.

57L Shi , L Libuda , E Schonau , et al. (2012) Long term higher urinary calcium excretion within the normal physiologic range predicts impaired bone status of the proximal radius in healthy children with higher potential renal acid load. Bone 50, 10261031.

58MS Oh (1989) A new method for estimating G-I absorption of alkali. Kidney Int 36, 915917.

62T Remer & F Manz (1995) Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc 95, 791797.

64F Grases , A Costa-Bauza & RM Prieto (2006) Renal lithiasis and nutrition. Nutr J 5, 23.

65OW Moe , MS Pearle & K Sakhaee (2011) Pharmacotherapy of urolithiasis: evidence from clinical trials. Kidney Int 79, 385392.

66A Sebastian , ST Harris , JH Ottaway , et al. (1994) Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. N Engl J Med 330, 17761781.

67DE Sellmeyer , M Schloetter & A Sebastian (2002) Potassium citrate prevents increased urine calcium excretion and bone resorption induced by a high sodium chloride diet. J Clin Endocrinol Metab 87, 20082012.

68M Maurer , W Riesen , J Muser , et al. (2003) Neutralization of Western diet inhibits bone resorption independently of K intake and reduces cortisol secretion in humans. Am J Physiol Renal Physiol 284, F32F40.

70K Rafferty , KM Davies & RP Heaney (2005) Potassium intake and the calcium economy. J Am Coll Nutr 24, 99106.

71S Jehle , A Zanetti , J Muser , et al. (2006) Partial neutralization of the acidogenic Western diet with potassium citrate increases bone mass in postmenopausal women with osteopenia. J Am Soc Nephrol 17, 32133222.

74L Ceglia , SS Harris , SA Abrams , et al. (2009) Potassium bicarbonate attenuates the urinary nitrogen excretion that accompanies an increase in dietary protein and may promote calcium absorption. J Clin Endocrinol Metab 94, 645653.

75B Dawson-Hughes , SS Harris , NJ Palermo , et al. (2009) Treatment with potassium bicarbonate lowers calcium excretion and bone resorption in older men and women. J Clin Endocrinol Metab 94, 96102.

77S Jehle , HN Hulter & R Krapf (2013) Effect of potassium citrate on bone density, microarchitecture, and fracture risk in healthy older adults without osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab 98, 207217.

78JB Cannata-Andia , P Roman-Garcia & K Hruska (2011) The connections between vascular calcification and bone health. Nephrol Dial Transplant 26, 34293436.

79L Wang , JE Manson & HD Sesso (2012) Calcium intake and risk of cardiovascular disease: a review of prospective studies and randomized clinical trials. Am J Cardiovasc Drugs 12, 105116.

80LA Frassetto , AC Hardcastle , A Sebastian , et al. (2012) No evidence that the skeletal non-response to potassium alkali supplements in healthy postmenopausal women depends on blood pressure or sodium chloride intake. Eur J Clin Nutr 66, 13151322.

82TR Fenton , AW Lyon , M Eliasziw , et al. (2009) Meta-analysis of the effect of the acid–ash hypothesis of osteoporosis on calcium balance. J Bone Miner Res 24, 18351840.

83RR McLean , N Qiao , KE Broe , et al. (2011) Dietary acid load is not associated with lower bone mineral density except in older men. J Nutr 141, 588594.

90JP Bonjour (2011) Calcium and phosphate: a duet of ions playing for bone health. J Am Coll Nutr 30, 438S448S.

91TR Fenton , AW Lyon , M Eliasziw , et al. (2009) Phosphate decreases urine calcium and increases calcium balance: a meta-analysis of the osteoporosis acid–ash diet hypothesis. Nutr J 8, 41.

92PD Miller , EN Schwartz , P Chen , et al. (2007) Teriparatide in postmenopausal women with osteoporosis and mild or moderate renal impairment. Osteoporos Int 18, 5968.

93J Coresh , BC Astor , T Greene , et al. (2003) Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 41, 112.

94JA Eustace , B Astor , PM Muntner , et al. (2004) Prevalence of acidosis and inflammation and their association with low serum albumin in chronic kidney disease. Kidney Int 65, 10311040.

95AC Looker , ES Orwoll , CC Johnston Jr, et al. (1997) Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 12, 17611768.

96CY Hsu & GM Chertow (2002) Elevations of serum phosphorus and potassium in mild to moderate chronic renal insufficiency. Nephrol Dial Transplant 17, 14191425.

97CY Hsu , SR Cummings , CE McCulloch , et al. (2002) Bone mineral density is not diminished by mild to moderate chronic renal insufficiency. Kidney Int 61, 18141820.

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