Intwke Protein intake and bone density has received various speaker honorariums ddensity is member of the German Nutrition Society. Ann Nutr Metab — An adequate bone strength is important for proper bone function [ 1 ], whereas low bone mineral density BMD is associated with an increased risk of osteoporotic fractures [ 2 ].

Protein intake and bone density -

During growth and pubertal maturation, impaired production and action of IGF-1 due to low protein intake may result in reduced bone development. A positive correlation between protein intake and bone mass gain can be detected in children.

For further information see Nutrition in Children and Adolescents. Dietary protein intake plays a critical role at older age. Osteoporos Int, Seniors with decreased protein intake are also more vulnerable to muscle weakness, sarcopenia and frailty, all contributing to increased risk of falling.

Adequate protein intake is particularly important for seniors with osteoporosis, and those at risk of malnutrition due to acute or chronic illness, or recovering from an injury.

Special considerations should be given to:. A balanced diet with sufficient protein intake, regardless whether of animal or vegetable source, benefits bone health when accompanied by adequate calcium intake. Foods high in protein include dairy foods, meat, poultry and fish, as well as eggs. Vegetable sources of protein include legumes e.

lentils, kidney beans , soya products e. tofu , grains, nuts and seeds. See list of protein rich foods. for adults 0. AI is the value that meets the needs of most children.

Accessed Although acid loading or a high protein diet is associated with increased urinary calcium excretion, which may be related to higher intestinal calcium absorption, higher protein intakes, whatever their origin animal or vegetable , do not appear to be harmful for bone health.

In fact, in the elderly, insufficient dietary protein intakes may be a more severe problem than protein excess [1] Rizzoli, R. Fruits and vegetables contain an array of vitamins, minerals, antioxidants and alkaline salts - some or all of which can have a beneficial effect on bone.

Intakes lower than 5 servings per day of fruit and vegetable consumption are associated with higher fracture risk and lower bone density in elderly men and women [3] Lin, P. J Nutr, PLoS One, When blood levels of vitamin B6, vitamin B12 and folic acid are low, homocysteine levels can rise and interfere with collagen synthesis.

Accordingly, inadequacy of B vitamins could compromise bone health, a notion supported by observational studies which found an association between high homocysteine levels and lower BMD, and increased hip fracture risk in older people [5] McLean, R. N Engl J Med, Jacques, and J.

Selhub, Relation between homocysteine and B-vitamin status indicators and bone mineral density in older Americans. Bone, However, a review concluded that inconsistencies within the current evidence base necessitate definitive studies to be conducted to evaluate the role of B vitamins in prevention of osteoporosis [7] Dai, Z.

and W. Koh, B-vitamins and bone health--a review of the current evidence. Nutrients, Approximately half of total body magnesium is stored in the skeleton.

Magnesium plays an important role in bone formation through stimulating proliferation of osteoblasts. Magnesium deficiency is rare in well-nourished populations, but magnesium absorption decreases with age and the elderly can be at risk of mild magnesium deficiency, particularly in response to diuretics or laxatives therapies.

Good sources of magnesium include green vegetables, legumes, nuts, seeds, unrefined grains, fish and dried fruit apricots, prunes, raisins [9] de Baaij, J. Hoenderop, and R. Bindels, Magnesium in man: implications for health and disease.

However, this hypothesis was challenged by the results of a recently published RCT, demonstrating an increased bone turnover among healthy adults by partial replacement of animal by plant protein [ 46 ].

Our umbrella review does neither reveal beneficial nor adverse effects on bone turnover markers by protein supplementation. In this regard, soy and animal protein did not differ substantially. In line with these findings, some have argued that the calciuretic effect of protein may be compensated by increased intestinal calcium absorption rather than bone loss [ 42 , 43 ].

We need to point out that the quality of SRs available to date has been limited, especially at the RCT level. Particularly, the quality of the SRs with MA on protein intake and BMD was only low to very low [ 22 , 28 ], with the exception of the SR with MA on high protein weight loss diets [ 21 ], which was of moderate quality.

A further major limitation is that most SRs with MA were not restricted to specific risk groups, such as older adults whose risk of fracture and of inadequate energy and protein intake is high, and whose requirement on daily protein intake is probably higher than currently assumed.

In addition, there was a wide and overlapping range of protein intake between groups with low and high protein intakes in different SRs and its underlying cohorts or RCTs, thus hampering the detection of clear dose-response relationships. Finally, it may be not clear why a classical GRADE assessment instead of NutriGrade was not performed.

We are aware that in the meantime, the GRADE approach was amended in a way that cohort studies can now also be assigned an initially high score, when risk of bias tools such as ROBINS-I are used [ 47 ].

However, the adjustments were not published until , whereas the guideline methodology for our umbrella review was established in Overall, available data regarding the impact of protein intake on bone health from SRs are insufficient to draw reliable conclusions for the general adult population.

Since osteoporotic fractures increase exponentially with higher age [ 31 ], and guidelines from expert consensus groups, such as the European Society on Parenteral and Enteral Nutrition ESPEN , already advocate a higher intake of protein than currently recommended 1.

In addition, more high-quality research regarding the effect of dose and type of protein on bone health in the entire adult population is needed. Turner CH Bone strength: current concepts. Ann N Y Acad Sci — Article PubMed Google Scholar. Hillier TA, Stone KL, Bauer DC et al Evaluating the value of repeat bone mineral density measurement and prediction of fractures in older women: the study of osteoporotic fractures.

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J Clin Epidemiol — Download references. We would like to thank all panel members of the guideline on protein intake for their contributions to the methodological approach and specifically to the present manuscript.

The following scientists deserve thanks for providing helpful remarks during guideline panel meetings and previous versions of this manuscript: Anna M. Amini, Jürgen M. Bauer, Heiner Boeing, Anette E.

Buyken, Anja Carlsohn, Tilman Kühn, Katharina Nimptsch, and Thomas Remer. This research was partly funded by the German Federal Ministry of Food and Agriculture.

The funder had no role in the decisions regarding data collection, analyses, interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

Clinic for Thoracic and Cardiovascular Surgery, Herz-und Diabeteszentrum Nordrhein Westfalen, Ruhr University Bochum, Bad Oeynhausen, Germany.

Science Department, German Nutrition Society, Bonn, Germany. Department of Nutrition and Food Science, Nutritional Physiology, University of Bonn, Bonn, Germany. Department of Nutrition and Food Science, Human Nutrition, University of Bonn, Bonn, Germany. Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany.

Institute of Nutritionals Sciences, Friedrich Schiller University Jena, Jena, Germany. Competence Cluster for Nutrition and Cardiovascular Health nutriCARD , Halle-Jena-, Leipzig, Germany.

Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany. Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.

Institute of Nutritional Science, University of Potsdam, Potsdam, Germany. German Center for Diabetes Research DZD , München-Neuherberg, Germany.

Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Department of Urology, University Stone Center, University Hospital Bonn, Bonn, Germany. Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Halle Saale , Halle, Germany.

Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany. Department of Aging Medicine and Aging Research, University Hospital Zurich, University of Zurich, and City Hospital Zurich, Zurich, Switzerland. You can also search for this author in PubMed Google Scholar.

AS, JH, NK, and AL conducted the systematic literature search, literature selection, data extraction, and AMSTAR 2 and NutriGrade evaluations. AZ and HBF evaluated the evidence graded the overall certainty of evidence, which was finalized after the discussion with all guideline panel members.

For example, it is now clear that the calcium loss related to protein intake is the most adverse when the diet is lowest in calcium intake i.

Thus, consuming foods rich in calcium, vitamin D and vitamin K can counter the potential negative effect of high protein consumption. For example, age-related guidelines for calcium intake show that different life stages require different amounts of calcium.

Individual consultation and guidance is important, especially for people with risk factors osteoporosis. i Massey LK. Dietary animal and plant protein and human bone health: a whole foods approach. J Nutr. The Negative Effects of Protein on Bone Health — and How to Counter Them Beginning 20 years ago, numerous studies were published on how consuming animal or vegetable protein affects bone composition.

Beginning 20 years ago, numerous anv were published on how consuming animal or vegetable protein affects bone intzke. Many studies found Athletic performance supplements Protein intake and bone density protein made bones less sturdy Vitamin B and cholesterol balance plant-based protein. Censity studies found that there was more osteoporosis thin bone tissue and fractures in people who ate a lot of meat. Healthy bones maintain a constant balance between how much old bone is broken down to be reabsorbed resorption and how much new bone is built modeling. Most people know that calcium and vitamin D are important for building and maintaining healthy bones. Thankfully, scientific exploration is a living, evolving process involving new methods for testing older theories. This raises more complex questions. Adequate an protein is essential Gone optimal bone denslty gain during growth and also Profein preserving bone and muscle mass iintake ageing. Crunchy energy bars childhood intame adolescence, protein plays a key role in ihtake mass acquisition. Lycopene antioxidant properties this stage Protein intake and bone density life, undernutrition, including insufficient caloric and protein intake, can severely impair bone development. Low protein intake lowers both the production and action of Insulin-like Growth Factor IGF-1which enhances bone formation. In addition, IGF-1 stimulates the intestinal absorption of the bone mineral elements calcium and phosphate, via an increase in the renal production of calcitriol, the hormonal form of vitamin D. In addition, IGF-1 directly stimulates the renal tubular reabsorption of phosphate. During growth and pubertal maturation, impaired production and action of IGF-1 due to low protein intake may result in reduced bone development.