HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sellmeyer, D. E Articles by Cummings, S. R Search for Related Content PubMed PubMed Citation Articles by Sellmeyer, D. E Articles by Cummings, S. R Agricola Articles by Sellmeyer, D. E Articles by Cummings, S. R

A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women^1,2,3

¹ From the Division of Endocrinology, the General Clinical Research Center, and the Department of Epidemiology and Biostatistics, University of California, San Francisco.

Background: Different sources of dietary protein may have different effects on bone metabolism. Animal foods provide predominantly acid precursors, whereas protein in vegetable foods is accompanied by base precursors not found in animal foods. Imbalance between dietary acid and base precursors leads to a chronic net dietary acid load that may have adverse consequences on bone.

Objective: We wanted to test the hypothesis that a high dietary ratio of animal to vegetable foods, quantified by protein content, increases bone loss and the risk of fracture.

Design: This was a prospective cohort study with a mean (±SD) of 7.0 ± 1.5 y of follow-up of 1035 community-dwelling white women aged >65 y. Protein intake was measured by using a food-frequency questionnaire and bone mineral density was measured by dual-energy X-ray absorptiometry.

Results: Bone mineral density was not significantly associated with the ratio of animal to vegetable protein intake. Women with a high ratio had a higher rate of bone loss at the femoral neck than did those with a low ratio (P = 0.02) and a greater risk of hip fracture (relative risk = 3.7, P = 0.04). These associations were unaffected by adjustment for age, weight, estrogen use, tobacco use, exercise, total calcium intake, and total protein intake.

Conclusions: Elderly women with a high dietary ratio of animal to vegetable protein intake have more rapid femoral neck bone loss and a greater risk of hip fracture than do those with a low ratio. This suggests that an increase in vegetable protein intake and a decrease in animal protein intake may decrease bone loss and the risk of hip fracture. This possibility should be confirmed in other prospective studies and tested in a randomized trial.

Key Words: Diet • protein • bone mineral density • bone loss • fracture • osteoporosis • women • aging • acid-base balance

This article has been cited by other articles:

				C. M Weaver Should dairy be recommended as part of a healthy vegetarian diet? Point Am. J. Clinical Nutrition, May 1, 2009; 89(5): 1634S - 1637S. [Abstract] [Full Text] [PDF]

				H. Jin and Y. Lu A Procedure for Determining Whether a Simple Combination of Diagnostic Tests May Be Noninferior to the Theoretical Optimum Combination Med Decis Making, November 1, 2008; 28(6): 909 - 916. [Abstract] [PDF]

				T. R Fenton, M. Eliasziw, A. W Lyon, S. C Tough, and D. A Hanley Meta-analysis of the quantity of calcium excretion associated with the net acid excretion of the modern diet under the acid-ash diet hypothesis Am. J. Clinical Nutrition, October 1, 2008; 88(4): 1159 - 1166. [Abstract] [Full Text] [PDF]

				R. P Heaney and D. K Layman Amount and type of protein influences bone health Am. J. Clinical Nutrition, May 1, 2008; 87(5): 1567S - 1570S. [Abstract] [Full Text] [PDF]

				J. Mardon, V. Habauzit, A. Trzeciakiewicz, M.-J. Davicco, P. Lebecque, S. Mercier, J.-C. Tressol, M.-N. Horcajada, C. Demigne, and V. Coxam Long-Term Intake of a High-Protein Diet with or without Potassium Citrate Modulates Acid-Base Metabolism, but Not Bone Status, in Male Rats J. Nutr., April 1, 2008; 138(4): 718 - 724. [Abstract] [Full Text] [PDF]

				H. Vatanparast, D. A. Bailey, A. D. G. Baxter-Jones, and S. J. Whiting The Effects of Dietary Protein on Bone Mineral Mass in Young Adults May Be Modulated by Adolescent Calcium Intake J. Nutr., December 1, 2007; 137(12): 2674 - 2679. [Abstract] [Full Text] [PDF]

				S. R. Cummings A 55-Year-Old Woman With Osteopenia JAMA, December 6, 2006; 296(21): 2601 - 2610. [Abstract] [Full Text] [PDF]

				K. L Penniston, N. Weng, N. Binkley, and S. A Tanumihardjo Serum retinyl esters are not elevated in postmenopausal women with and without osteoporosis whose preformed vitamin A intakes are high Am. J. Clinical Nutrition, December 1, 2006; 84(6): 1350 - 1356. [Abstract] [Full Text] [PDF]

				S. Jehle, A. Zanetti, J. Muser, H. N. Hulter, and R. Krapf Partial Neutralization of the Acidogenic Western Diet with Potassium Citrate Increases Bone Mass in Postmenopausal Women with Osteopenia J. Am. Soc. Nephrol., November 1, 2006; 17(11): 3213 - 3222. [Abstract] [Full Text] [PDF]

				J.-P. Bonjour Dietary Protein: An Essential Nutrient For Bone Health J. Am. Coll. Nutr., December 1, 2005; 24(suppl_6): 526S - 536S. [Abstract] [Full Text] [PDF]

				A. Sebastian Dietary protein content and the diet's net acid load: opposing effects on bone health Am. J. Clinical Nutrition, November 1, 2005; 82(5): 921 - 922. [Full Text] [PDF]

				S. R. Zwart, J. E. Davis-Street, D. Paddon-Jones, A. A. Ferrando, R. R. Wolfe, and S. M. Smith Amino acid supplementation alters bone metabolism during simulated weightlessness J Appl Physiol, July 1, 2005; 99(1): 134 - 140. [Abstract] [Full Text] [PDF]

				H. M Macdonald, S. A New, W. D Fraser, M. K Campbell, and D. M Reid Low dietary potassium intakes and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal women and increased markers of bone resorption in postmenopausal women Am. J. Clinical Nutrition, April 1, 2005; 81(4): 923 - 933. [Abstract] [Full Text] [PDF]

				A. J. Lanou, S. E. Berkow, and N. D. Barnard Calcium, Dairy Products, and Bone Health in Children and Young Adults: A Reevaluation of the Evidence Pediatrics, March 1, 2005; 115(3): 736 - 743. [Abstract] [Full Text] [PDF]

				L. Frassetto, R. C. Morris Jr., and A. Sebastian Long-Term Persistence of the Urine Calcium-Lowering Effect of Potassium Bicarbonate in Postmenopausal Women J. Clin. Endocrinol. Metab., February 1, 2005; 90(2): 831 - 834. [Abstract] [Full Text] [PDF]

				Z. K. Roughead, J. R. Hunt, L. K. Johnson, T. M. Badger, and G. I. Lykken Controlled Substitution of Soy Protein for Meat Protein: Effects on Calcium Retention, Bone, and Cardiovascular Health Indices in Postmenopausal Women J. Clin. Endocrinol. Metab., January 1, 2005; 90(1): 181 - 189. [Abstract] [Full Text] [PDF]

				H. Jin, Y. Lu, K. Stone, and D. M. Black Alternative Tree-Structured Survival Analysis Based on Variance of Survival Time Med Decis Making, November 1, 2004; 24(6): 670 - 680. [Abstract] [PDF]

				S. R Zwart, A. R Hargens, and S. M Smith The ratio of animal protein intake to potassium intake is a predictor of bone resorption in space flight analogues and in ambulatory subjects Am. J. Clinical Nutrition, October 1, 2004; 80(4): 1058 - 1065. [Abstract] [Full Text] [PDF]

				H. Jin, Y. Lu, S. T. Harris, D. M. Black, K. Stone, M. C. Hochberg, and H. K. Genant Classification Algorithms for Hip Fracture Prediction Based on Recursive Partitioning Methods Med Decis Making, August 1, 2004; 24(4): 386 - 398. [Abstract] [PDF]

				J. Bowen, M. Noakes, and P. M. Clifton A High Dairy Protein, High-Calcium Diet Minimizes Bone Turnover in Overweight Adults during Weight Loss J. Nutr., March 1, 2004; 134(3): 568 - 573. [Abstract] [Full Text] [PDF]

				Y.-M. Chen, S. C. Ho, S. S. H. Lam, S. S. S. Ho, and J. L. F. Woo Soy Isoflavones Have a Favorable Effect on Bone Loss in Chinese Postmenopausal Women with Lower Bone Mass: A Double-Blind, Randomized, Controlled Trial J. Clin. Endocrinol. Metab., October 1, 2003; 88(10): 4740 - 4747. [Abstract] [Full Text] [PDF]

				K. D. Setchell and E. Lydeking-Olsen Dietary phytoestrogens and their effect on bone: evidence from in vitro and in vivo, human observational, and dietary intervention studies Am. J. Clinical Nutrition, September 1, 2003; 78(3): 593S - 609. [Abstract] [Full Text] [PDF]

				D. J. Jenkins, C. W. Kendall, A. Marchie, A. L Jenkins, L. S. Augustin, D. S Ludwig, N. D Barnard, and J. W Anderson Type 2 diabetes and the vegetarian diet Am. J. Clinical Nutrition, September 1, 2003; 78(3): 610S - 616. [Abstract] [Full Text] [PDF]

				P. B Rapuri, J C. Gallagher, and V. Haynatzka Protein intake: effects on bone mineral density and the rate of bone loss in elderly women Am. J. Clinical Nutrition, June 1, 2003; 77(6): 1517 - 1525. [Abstract] [Full Text] [PDF]

				Z. K. (F. Roughead, L. K. Johnson, G. I. Lykken, and J. R. Hunt Controlled High Meat Diets Do Not Affect Calcium Retention or Indices of Bone Status in Healthy Postmenopausal Women J. Nutr., April 1, 2003; 133(4): 1020 - 1026. [Abstract] [Full Text] [PDF]

				Z. K. (F. Roughead Is the Interaction between Dietary Protein and Calcium Destructive or Constructive for Bone?: Summary J. Nutr., March 1, 2003; 133(3): 866S - 869. [Full Text] [PDF]

				M. Maurer, W. Riesen, J. Muser, H. N. Hulter, and R. Krapf Neutralization of Western diet inhibits bone resorption independently of K intake and reduces cortisol secretion in humans Am J Physiol Renal Physiol, January 1, 2003; 284(1): F32 - F40. [Abstract] [Full Text] [PDF]

				S. J. Whiting, J. L. Boyle, A. Thompson, R. L. Mirwald, and R. A. Faulkner Dietary Protein, Phosphorus and Potassium Are Beneficial to Bone Mineral Density in Adult Men Consuming Adequate Dietary Calcium J. Am. Coll. Nutr., October 1, 2002; 21(5): 402 - 409. [Abstract] [Full Text] [PDF]

				M. Peacock, C. H. Turner, M. J. Econs, and T. Foroud Genetics of Osteoporosis Endocr. Rev., June 1, 2002; 23(3): 303 - 326. [Abstract] [Full Text] [PDF]

				R. P Heaney Protein and calcium: antagonists or synergists? Am. J. Clinical Nutrition, April 1, 2002; 75(4): 609 - 610. [Full Text] [PDF]

				B. Dawson-Hughes and S. S Harris Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women Am. J. Clinical Nutrition, April 1, 2002; 75(4): 773 - 779. [Abstract] [Full Text] [PDF]

				J. H. E. Promislow, D. Goodman-Gruen, D. J. Slymen, and E. Barrett-Connor Protein Consumption and Bone Mineral Density in the Elderly : The Rancho Bernardo Study Am. J. Epidemiol., April 1, 2002; 155(7): 636 - 644. [Abstract] [Full Text] [PDF]

				A. Sebastian, D. E Sellmeyer, K. L Stone, and S. R Cummings Dietary ratio of animal to vegetable protein and rate of bone loss and risk of fracture in postmenopausal women Am. J. Clinical Nutrition, September 1, 2001; 74(3): 411 - 412. [Full Text]

				R. P Heaney Protein intake and bone health: the influence of belief systems on the conduct of nutritional science Am. J. Clinical Nutrition, January 1, 2001; 73(1): 5 - 6. [Full Text] [PDF]