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Developed in conjunction with The American Academy of Family
Physicians, The American Academy of Pediatrics, The American Dietetic
Association, and The National Medical Association.
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Dairy Council Digest Archives
Dietary Protein & Bone Health: New Perspectives
Summary
Prevention of osteoporosis is a public health priority. Among nutritional factors, most attention has focused on the beneficial role of calcium and calcium-rich foods (e.g., dairy products). However, in addition to calcium, many other nutrients are necessary for bone health. Protein is critical for the skeleton, yet this nutrient has also been regarded as detrimental to bone. Recent research has led to a new perspective on dietary protein and bone health.
Excess dietary protein, particularly purified proteins, increases urinary calcium excretion. This calcium loss could potentially cause negative calcium balance, leading to bone loss and osteoporosis. These effects have been attributed to an increased endogenous acid load created by the metabolism of protein, which requires neutralization by alkaline salts of calcium from bone. However, this theory is controversial. In a recent investigation in which women consumed a high protein intake from food sources (meat), renal acid excretion initially increased but abated over time. Hypercalciuria was not induced nor was bone adversely affected.
Findings from many, but not all, epidemiological studies point to a beneficial role for dietary protein in bone health. High protein intakes have been associated with reduced bone loss, high bone mineral density, and reduced fracture risk in older adults. However, other studies have failed to show a positive association between protein intake and bone health. The effect of different types of protein – animal protein versus plant-based protein – on the skeleton is debated.
Low dietary protein intake has been associated with low bone mineral density and greater fracture risk in older adults. In a recent trial, increasing protein intake, especially when accompanied by calcium and vitamin D, reduced bone loss, improved muscle strength, and shortened the hospital stay in older patients with hip fractures whose usual intake of dietary protein was low.
Controversy regarding protein's effects on bone health may be explained by other nutrients in food sources of protein or the whole diet. For example, dietary protein has been shown to exert a positive effect on the skeleton of older adults when calcium intake is adequate, but not when calcium intake is low. Also, phosphorus (e.g., in meat and milk) and potassium (e.g., in milk, legumes, and grains) are hypocalciuric, which may counteract the hypercalciuric effect of protein.
Because protein exists in close association with other nutrients in the diet, it is important to consider protein's role in bone health in the context of foods or the overall dietary pattern. A number of studies have demonstrated that intake of milk and other dairy products benefits bone health. Dairy products such as milk are a unique source of protein because their calcium content is high relative to their protein content and they contain other bone-supporting nutrients such as phosphorus, magnesium, zinc, and vitamins A, D, and K.
More research is needed to better understand protein's role in bone health. Future studies should examine the effect of interactions among nutrients on bone health in the context of the total diet in all segments of the population.
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