title: Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. The effects of a 30-month dietary intervention on bone mineral density: the Postmenopausal Health Study. Protein consumption and bone fractures in women. Biomarker-calibrated protein intake and bone health in the Women's Health Initiative clinical trials and observational study. Influence of a fermented protein-fortified dairy product on serum insulin-like growth factor-I in women with anorexia nervosa: A randomized controlled trial. Vegetable and Fruit Intake and Fracture-Related Hospitalisations: A Prospective Study of Older Women A diet high in protein, dairy, and calcium attenuates bone loss over twelve months of weight loss and maintenance relative to a conventional high-carbohydrate diet in adults. Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Study of Osteoporotic Fractures Research Group. Fruit and Vegetable Intake and Hip Fracture Incidence in Older Men and Women: The CHANCES Project. Comparative effects of oral aromatic and branched-chain amino acids on urine calcium excretion in humans Effect of calcium fortified milk supplementation with or without vitamin K on biochemical markers of bone turnover in premenopausal women. Inhibition of bone turnover by milk intake in postmenopausal women. Dietary acid load, kidney function, osteoporosis, and risk of fractures in elderly men and women Adherence to a vegetable-fruit-soy dietary pattern or the Alternative Healthy Eating Index is associated with lower hip fracture risk among Singapore Chinese. Neutralization of Western diet inhibits bone resorption independently of K intake and reduces cortisol secretion in humans. Body composition and strength changes in women with milk and resistance exercise. Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford Low iron status as a factor of increased bone resorption and effects of an iron and vitamin D-fortified skimmed milk on bone remodelling in young Spanish women Gender-specific associations between soy and risk of hip fracture in the Singapore Chinese Health Study. Proteins, dietary acid load, and calcium and risk of postmenopausal fractures in the E3N French women prospective study. Fruit and vegetable intake and risk of hip fracture: a cohort study of Swedish men and women. Bone mineral density in postmenopausal Chinese women treated with calcium fortification in soymilk and cow's milk The Effect of a Whey Protein Supplement on Bone Mass in Older Caucasian Adults. Calcium- and vitamin D3-fortified milk reduces bone loss at clinically relevant skeletal sites in older men: a 2-year randomized controlled trial. Inhibition of markers of bone resorption by consumption of vitamin D and calcium-fortified soft plain cheese by institutionalised elderly women. Effects of a multi-component exercise program and calcium–vitamin-D3-fortified milk on bone mineral density in older men: a randomised controlled trial Calcium, diet and fracture risk: a prospective study of 1898 incident fractures among 34 696 British women and men. Consumption of vitamin D-and calcium-fortified soft white cheese lowers the biochemical marker of bone resorption TRAP 5b in postmenopausal women at moderate risk of osteoporosis fracture. The impact of dietary protein on calcium absorption and kinetic measures of bone turnover in women. Phosphate and carbonate salts of calcium support robust bone building in osteoporosis. Effect of milk and calcium supplementation on bone density and bone turnover in pregnant Chinese women: a randomized controlled trail The effect of milk supplementation on bone mineral density in postmenopausal Chinese women in Malaysia Risk factors for hip fracture in white men: the NHANES I Epidemiologic Follow-up Study. Effect of protein supplementation during a 6-month strength and conditioning program on areal and volumetric bone parameters. Does dietary protein reduce hip fracture risk in elders? The Framingham osteoporosis study Long-term effects of calcium-vitamin-D3-fortified milk on bone geometry and strength in older men. Possible site-specific effect of an intervention combining nutrition and lifestyle counselling with consumption of fortified dairy products on bone mass: the Postmenopausal Health Study II Potassium bicarbonate attenuates the urinary nitrogen excretion that accompanies an increase in dietary protein and may promote calcium absorption. Potassium citrate supplementation results in sustained improvement in calcium balance in older men and women. Dietary protein intake and risk of osteoporotic hip fracture in elderly residents of Utah. The effects of a two-year randomized, controlled trial of whey protein supplementation on bone structure, IGF-1, and urinary calcium excretion in older postmenopausal women. Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss. Protein Supplements Increase Serum Insulin-Like Growth Factor-I Levels and Attenuate Proximal Femur Bone Loss in Patients with Recent Hip Fracture Milk supplementation and bone health in young adult chinese women. Nutrition and subsequent hip fracture risk among a national cohort of white women. Milk supplementation prevents bone loss in postmenopausal Chinese women over 3 years. Risk Factors for Hip Fracture in Older Men: The Osteoporotic Fractures in Men Study (MrOS). Milk Basic Protein (MBP) Increases Radial Bone Mineral Density in Healthy Adult Women Potassium Bicarbonate Supplementation Lowers Bone Turnover and Calcium Excretion in Older Men and Women: A Randomized Dose-Finding Trial. Whey Protein Supplementation and Higher Total Protein Intake Do Not Influence Bone Quantity in Overweight and Obese Adults Following a 36-Week Exercise and Diet Intervention. A follow-up study on the effects of a milk supplement on bone mineral density of postmenopausal Chinese women in Malaysia. Areal and volumetric bone mineral density and geometry at two levels of protein intake during caloric restriction: a randomized, controlled trial. Effect of potassium citrate on bone density, microarchitecture, and fracture risk in healthy older adults without osteoporosis: a randomized controlled trial.
abstract: Dietary data from a prospect i ve study were used to relate factors influencing calcium balance ( estimates of dietary calcium intake , protein intake from nondairy animal sources ( meat , fish , and eggs ) , and coffee consumption ) to the incidence of  hip fracture . During the years 1977 - 1983 , women and men born between 1925 and 1940 and living in one of three Norwegian counties were invited to a  cardiovascular screening that included a dietary survey . The attendance rate at screening was 91.1 % , and 90.7 % of these persons ( 19,752 women and 20,035 men ) filled in and returned a semiquantitative dietary question naire . This cohort was followed for an average of 11.4 years ( range , 0.01 - 13.8 years ) with respect to hip fracture , defined as cervical or trochanteric fracture . During follow-up , 213 hip fractures were identified , excluding fractures associated with high-energy trauma and metastatic bone disease . There was no clear association between  calcium intake or nondairy animal protein intake  and hip fracture in this cohort . However , an elevated risk of fracture was found in women with a high intake of protein from nondairy animal sources in the presence of low calcium intake ( relative risk = 1.96 ( 95 % confidence interval 1.09 - 3.56 ) for the highest quarter of nondairy protein intake and the lowest quarter of calcium intake vs. the three lower quarters of protein intake and the three higher quarters of calcium intake ) . Women who drank nine or more cups of coffee per day also had an increased risk of fracture , while there was no association between coffee consumption and hip fracture in men . Although these findings do not necessarily imply causal relations , they suggest the presence of risk factors for hip fracture that act through a negative calcium balance in this population Low dietary Ca intake and vitamin D insufficiency have been implicated as part of the aetiology leading to osteoporosis . The aim of the present study was to examine the effects of a 30-month dietary intervention that combined supplementation of dairy products fortified with Ca and vitamin D3 and lifestyle and nutrition counselling sessions on  bone mineral density ( BMD )  of postmenopausal women . Sixty-six postmenopausal women ( aged 55 - 65 years ) were r and omised into a dietary group ( DG ; n 35 ) , receiving daily and for the first 12 months 1200 mg Ca and 7.5 microg vitamin D3 , while for the next 18 months of intervention 1200 mg Ca and 22.5 microg vitamin D3 through fortified dairy products , and a control group ( CG ; n 31 ) receiving neither counselling nor dairy products . The DG was found to have more favourable changes in arms ( P < 0.001 ) , total spine ( P = 0.001 ) and total body BMD ( P < 0.001 ) compared with the CG . Furthermore , a significant increase was observed for the DG in lumbar spine BMD ( 0.056 ; 95 % CI 0.009 , 0.103 ) , which was not found to differentiate significantly compared with the change observed in the CG ( P = 0.075 ) . In conclusion , the present study showed that intakes of vitamin D of about 22.5 microg/d and of Ca close to the recommended level of 1200 mg from fortified dairy foods for 30 months , with compliance ensured by lifestyle and nutrition counselling sessions , can induce favourable changes in arms , total spine and total body BMD of postmenopausal women Dietary protein increases urinary calcium losses and has been associated with higher rates of hip fracture in cross-cultural studies . However , the relation between protein and risk of  osteoporotic bone fractures among individuals has not been examined in detail . In this prospect i ve study , usual dietary intake was measured in 1980 in a cohort of 85,900 women , aged 35 - 59 years , who were participants in the Nurses ' Health Study . A mailed food frequency question naire was used and incident hip ( n = 234 ) and distal forearm ( n = 1,628 ) fractures were identified by self-report during the following 12 years . Information on other factors related to osteoporosis , including obesity , use of postmenopausal estrogen , smoking , and physical activity , was collected on biennial question naires . Dietary measures were up date d in 1984 and 1986 . Protein was associated with an increased risk of forearm fracture ( relative risk ( RR ) = 1.22 , 95 % confidence interval ( Cl ) 1.04 - 1.43 , p for trend = 0.01 ) for women who consumed more than 95 g per day compared with those who consumed less than 68 g per day . A similar increase in risk was observed for animal protein , but no association was found for consumption of vegetable protein . Women who consumed five or more servings of red meat per week also had a significantly increased risk of forearm fracture ( RR = 1.23 , 95 % Cl 1.01 - 1.50 ) compared with women who ate red meat less than once per week . Recall of teenage diet did not reveal any increased risk of forearm fracture for women with higher consumption of animal protein or red meat during this earlier period of life . No association was observed between  adult protein intake  and the incidence of hip fractures , though power to assess this association was low BACKGROUND The effects of dietary protein on bone health are controversial . OBJECTIVE We examined the relation between protein intake with fracture and  bone mineral density ( BMD )  within the Women 's Health Initiative ( WHI ) . DESIGN This prospect i ve analysis included 144,580 women aged 50 - 79 y at baseline in the WHI clinical trials ( CTs ) and observational study ( OS ) that recruited participants in 1993 - 1998 with follow-up through 2011 . Self-reported clinical fractures were collected semiannually through the original end of the trials ( WHI CTs ) and annually ( WHI OS ) by question naires . Hip fracture was adjudicated by a central review of radiology reports . BMDs for total body , hip , and spine were measured at baseline and 3 and 6 y in 9062 women at 3 WHI clinics by using dual-energy X-ray absorptiometry .  Protein intake was assessed via food-frequency question naire and calibrated by using biomarkers of energy and protein intakes . Associations between protein intake and fracture were estimated by using Cox proportional hazards regression , and the relation between protein intake and BMD was estimated by using linear regression . RESULTS Median biomarker-calibrated protein intake was 15 % of energy intake . Per 20 % increase in calibrated protein intake ( percentage of energy ) , there was no significant association with total fracture ( HR : 0.99 ; 95 % CI : 0.97 , 1.02 ) or hip fracture ( HR : 0.91 ; 95 % CI : 0.84 , 1.00 ) , but there was an inverse association with forearm fracture ( HR : 0.93 ; 95 % CI : 0.88 , 0.98 ) . Each 20 % increase in calibrated protein intake was associated with a significantly higher BMD for total body ( mean 3-y change : 0.003 g/cm² ; 95 % CI : 0.001 , 0.005 g/cm² ) and hip ( mean 3-y change : 0.002 g/cm² ; 95 % CI : 0.001 , 0.004 g/cm² ) . CONCLUSIONS Higher biomarker-calibrated protein intake within the range of usual intake was inversely associated with forearm fracture and was associated with better maintenance of total and hip BMDs . These data suggest higher protein intake is not detrimental to bone health in postmenopausal women BACKGROUND & AIMS Patients with anorexia nervosa ( AN ) have low serum IGF-I levels that may contribute to a lower bone mineral mass . We investigated the effects of a fermented , protein-fortified , dairy product on serum IGF-I levels in patients with AN during an in-hospital refeeding program . METHODS In this multicenter , r and omized , double-blind , placebo-controlled , clinical trial conducted at 3 university hospitals and 3 private clinics in France and Switzerl and , 62 women recently admitted with confirmed AN and with a baseline low serum IGF-I level were r and omized to 2 daily isocaloric fresh cheese pots containing either 15 g/150 g or 3 g/150 g ( controls ) of protein for 4 weeks . The primary outcome was the change in IGF-I levels . RESULTS In the primary intention-to-treat analysis , mean serum IGF-I levels increased during the intervention phase from 22.9 ± 1.5 to 28.6 ± 1.3 nmol/L ( means ± SEM ) ( + 20.2 % ) in the intervention group and from 20.2 ± 1.2 to 25.7 ± 1.5 nmol/L ( + 16.8 % ) in controls . In a preplanned analysis of covariance with repeated measures , the between-group difference was close to statistical significance ( P = 0.071 ) . In a post-hoc mixed-regression model analysis , the difference was statistically significant ( 4.9 nmol/l increase ; P = 0.003 ) , as was the change of the ratio IGF-I/IGF-BP3 ( P=0.004 ) . There was no between-group difference in biochemical markers of bone turnover ( osteocalcin , P1NP , CTX ) or in serum parathyroid hormone level . Serum calcium levels slightly increased during the intervention phase in the higher protein group ( P = 0.02 ) . IGF-BP2 decreased significantly more in the intervention group during the follow up period at week 4 after supplements cessation ( P = 0.019 ) . CONCLUSIONS Intake of a fermented , protein-fortified , isocaloric dairy product during 4 weeks may slightly increase serum IGF-I levels in women with AN , without significant changes in bone turnover markers . CLINICAL TRIAL REGISTRATION NUMBER NCT01823822 ( www . clinical trials.gov ) The importance of vegetable and fruit intakes for the prevention of  fracture in older women is not well understood . Few studies have explored vegetable and fruit intakes separately , or the associations of specific types of vegetables and fruits with fracture hospitalisations . The objective of this study was to examine the associations of vegetable and fruit intakes , separately , and specific types of vegetables and fruits with fracture-related hospitalisations in a prospect i ve cohort of women aged ≥70 years .  Vegetable and fruit intakes were assessed at baseline ( 1998 ) in 1468 women using a food frequency question naire .  The incidence of fracture-related hospitalisations over 14.5 years of follow-up was determined using the Hospital Morbidity Data Collection , linked via the Western Australian Data Linkage System . Fractures were identified in 415 ( 28.3 % ) women , of which 158 ( 10.8 % ) were hip fractures . Higher intakes of vegetables , but not fruits , were associated with lower fracture incidence . In multivariable-adjusted models for vegetable types , cruciferous and allium vegetables were inversely associated with all fractures , with a hazard ratio ( HR ) ( 95 % confidence interval ) of 0.72 ( 0.54 , 0.95 ) and 0.66 ( 0.49 , 0.88 ) , respectively , for the highest vs. lowest quartiles . Increasing vegetable intake , with an emphasis on cruciferous and allium vegetables , may prevent fractures in older postmenopausal women Weight loss causes  bone mineral loss .  Higher protein diets continue to be criticized for further potential harmful bone effects , including elevated urinary calcium , but may promote bone health if protein sources include dairy . Overweight middle-aged subjects ( n = 130 , 59 males ) were r and omized to a diet providing 1.4 g.kg(-1).d(-1 ) protein and 3 daily servings of dairy ( PRO ) or 0.8 g.kg(-1).d(-1 ) protein and 2 daily servings of dairy ( CARB ) for 4 mo of weight loss plus 8 mo of weight maintenance . Diets prescribed 6276 kJ/d for females and 7113 kJ/d for males . Bone mineral content and density ( BMD ) for whole body ( WB ) , lumbar spine ( LS ) and total hip ( TH ) were measured using dual X-ray absorptiometry , and dietary intake using 3-d weighed food records . Urinary calcium was measured using 24-h collection at 0 and 8 mo for a sub sample ( n = 42 ) . Participants lost body weight ( mean , 95 % CI ) of 8.2 % ( 7.5 - 8.9 % ) at 4 mo , 10.6 % ( 9.5 - 11.8 % ) at 8 mo , and 10.5 % ( 8.9 - 12.0 % ) at 12 mo without differences between groups at any time ( P = 0.64 ) . At 12 mo , PRO BMD was higher by 1.6 % ( 0.3 - 3.0 % ) at WB , 2.1 % ( 0.6 - 3.7 % ) at LS , and 1.4 % ( 0.2 - 2.5 % ) at TH compared with  CARB  .  PRO calcium intake was higher ( PRO : 1140 + /- 58 mg/d , CARB : 766 + /- 46 ; P < 0.01 ) , as was urinary calcium ( PRO : 163 + /- 15 mg/d , CARB : 100 + /- 9.2 ; P < 0.01 ) . A reduced-energy diet supplying 1.4 g.kg(-1).d(-1 ) protein and 3 dairy servings increased urinary calcium excretion but provided improved calcium intake and attenuated bone loss over 4 mo of weight loss and 8 additional mo of weight maintenance BACKGROUND There is currently no consensus on the effect of dietary protein intake on the skeleton , but there is some indication that low calcium intakes adversely influence the effect of dietary protein on fracture risk . OBJECTIVE The objective of the present study was to determine whether supplemental calcium citrate malate and vitamin D influence any associations between  protein intake and change in bone mineral density ( BMD ) . DESIGN Associations between protein intake and change in BMD were examined in 342 healthy men and women ( aged > or = 65 y ) who had completed a 3-y , r and omized , placebo-controlled trial of calcium and vitamin D supplementation . Protein intake was assessed at the midpoint of the study with the use of a food-frequency question naire and  BMD  was assessed every 6 mo by dual-energy X-ray absorptiometry . RESULTS The mean ( + /-SD ) protein intake of all subjects was 79.1 + /- 25.6 g/d and the mean total calcium intakes of the supplemented and placebo groups were 1346 + /- 358 and 871 + /- 413 mg/d , respectively . Higher protein intake was significantly associated with a favorable 3-y change in total-body BMD in the supplemented group ( in a model containing terms for age , sex , weight , total energy intake , and dietary calcium intake ) but not in the placebo group . The pattern of change in femoral neck BMD with increasing protein intake in the supplemented group was similar to that for the total body . CONCLUSION Increasing protein intake may have a favorable effect on change in BMD in elderly subjects supplemented with calcium citrate malate and vitamin 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 prospect i ve 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 question naire 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 prospect i ve studies and tested in a r and omized trial The role of fruit and vegetable intake in relation to fracture prevention during adulthood and beyond is not adequately understood . We investigated the potential association between fruit and vegetable intake  and hip fracture incidence in a large sample of older adults from Europe and the United States . A total of 142,018 individuals ( 116,509 women ) aged ≥60 years , from five cohorts , were followed up prospect ively for 1,911,482 person-years , accumulating 5552 hip fractures .  Fruit and vegetable intake  was assessed by vali date d , cohort-specific , food-frequency question naires ( FFQ ) . Ηip fractures were ascertained through national patient registers or telephone interviews/ question naires . Adjusted hazard ratios ( HRs ) derived by Cox proportional hazards regression were estimated for each cohort and subsequently pooled using r and om effects meta- analysis . Intake of ≤1 serving/day of fruit and vegetables combined was associated with 39 % higher hip fracture risk ( pooled adjusted HR , 1.39 ; 95 % confidence interval [ CI ] , 1.20 to 1.58 ) in comparison with moderate intake ( > 3 and ≤5 servings/day ) ( pfor heterogeneity = 0.505 ) , whereas higher intakes ( > 5 servings/day ) were not associated with lower risk in comparison with the same reference . Associations were more evident among women . We concluded that a daily intake of 1 or < 1 servings of fruits and vegetables was associated with increased hip fracture risk in relation to moderate daily intakes . Older adults with such low fruit and vegetable consumption may benefit from raising their intakes to moderate amounts in order to reduce their hip fracture risk . © 2016 American Society for Bone and Mineral Research Summary In 30 adults , increasing intake of aromatic amino acids increased calcium excretion and serum IGF-1 , but not indices of bone turnover , when compared with similar increases in intake of branched-chain amino acids . The mechanisms involved are not certain but these findings suggest a role for the calcium sensor receptor . Introduction In contrast to branched-chain amino acids ( BCAAs ) , aromatic amino acids ( AAAs ) bind to the calcium sensing receptor ( CaR ) and thus have an increased potential to affect calcium homeostasis . In this study we compare the effects of increased intake of AAAs versus BCAAs on calcium excretion , serum IGF-1 , markers of bone turnover , and 4-hr calcium excretion after an oral calcium load . Methods After two weeks on low-protein metabolic diets , 30 healthy subjects were r and omized to a fivefold increase in intake of AAAs or BCAAs for two weeks . Changes in calcium excretion and other measures were compared in the two groups . Results With the increase in amino acid intake , 24-hr calcium excretion ( P = 0.027 ) , IGF-1 ( P = 0.022 ) , and 4-hr calcium excretion after an oral load ( P = 0.023 ) increased significantly in the AAA relative to the BCAA group . Group changes in turnover markers did not differ significantly . Conclusion In comparison with BCAAs , AAAs promoted calcium excretion . The calciuria does not appear to result from increases in bone resorption and may occur by increasing calcium absorption . The AAAs also increased circulating levels of IGF-1 . Collectively these findings raise the possibility that AAAs may selectively influence calcium homeostasis through their interactions with the OBJECTIVE We compared the effect of supplementation with a fortified skimmed milk product ( high calcium skim milk ) with or without added phylloquinone ( vitamin K(1 ) ) on markers of bone formation and resorption in premenopausal women . METHODS Eighty-two women 20 to 35 y of age were r and omly allocated to three groups . Two groups received two daily servings of high calcium skim milk ( 1000 mg/d of extra calcium ) with or without added phylloquinone ( 80 microg/d ) for 16 wk , and a third control group received no supplementation .  Bone density was assessed at baseline and the bone markers , total osteocalcin , type I N-terminal procollagen peptide , and cross-linked C-telopeptide of type I collagen were measured at baseline and at weeks 2 , 12 , and 16 . Serum phylloquinone and undercarboxylated osteocalcin were measured in the control and vitamin K-supplemented groups at weeks 0 and 16 . RESULTS Baseline values for age , body mass index , and bone density did not differ across groups . In vitamin K-supplemented women , mean serum phylloquinone concentrations increased from 0.27 to 0.76 microg/L ( P < 0.05 ) and undercarboxylated osteocalcin concentrations decreased from 9.68 to 4.46 microg/L ( P < 0.05 ) over 16 wk . Plasma cross-linked C-telopeptide of type I collagen , total osteocalcin , and type I N-terminal procollagen peptide levels decreased significantly in both supplemented groups compared with the control group over 16 wk ( cross-linked C-telopeptide of type I collagen > 30 % , total osteocalcin and type I N-terminal procollagen peptide > 15 % ) . CONCLUSION Fortified milk supplementation  in premenopausal women reduced bone turnover significantly . Phylloquinone fortification substantially improved vitamin K status but had no demonstrable additive effect on bone turnover in this short-term study Increased postmenopausal bone turnover leads to bone loss and fragility fracture risk . In the absence of osteoporosis , risk preventive measures , particularly those modifying nutritional lifestyle , are appropriate . We tested the hypothesis that milk supplementation affects bone turnover related to biochemical markers in a direction that , in the long term , may be expected to reduce  postmenopausal bone loss .  Thirty healthy postmenopausal women aged 59.3 ( SD 3.3 ) years were enrolled in a prospect i ve crossover trial of 16 weeks . After a 4-week period of adaptation with diet providing 600 mg calcium plus 300 mg ingested as 250 ml semi-skimmed milk , participants were maintained during 6 weeks under the same 600 mg calcium diet and r and omized to receive either 500 ml semi-skimmed milk , thus providing a total of 1200 mg calcium , or no milk supplement . In the next 6 weeks they were switched to the alternative regimen . At the end of the each period , i.e. after 4 , 10 and 16 weeks , blood and urinary sample s were collected . The changes in blood variables between the periods of 6 weeks without and with milk supplementation were : for parathyroid hormone , -3.2 pg/ml ( P=0.0054 ) ; for crosslinked telopeptide of type I collagen , -624 pg/ml ( P<0.0001 ) ; for propeptide of type I procollagen , -5.5 ng/ml ( P=0.0092 ) ; for osteocalcin , -2.8 ng/ml ( P=0.0014 ) . In conclusion , a 6-week period of milk supplementation induced a decrease in several biochemical variables compatible with diminished bone turnover mediated by reduction in parathyroid hormone secretion . This nutritional approach to postmenopausal alteration in bone metabolism may be a valuable measure in the primary prevention of osteoporosis Summary Because kidney dysfunction reduces the ability to excrete dietary acid excess , we hypothesized that underlying kidney function may have confounded the mixed studies linking dietary acid load with the risk of osteoporosis and fractures in the community . In a relatively large survey of elderly men and women , we report that dietary acid load did neither associate with DEXA-estimated bone mineral density nor with fracture risk . Underlying kidney function did not modify these null findings . Our results do not support the dietary acid-base hypothesis of bone loss . Introduction Impaired renal function reduces the ability to excrete dietary acid excess . We here investigate the association between dietary acid load and bone mineral density ( BMD ) , osteoporosis , and fracture risk by renal function status . Methods An observational study was conducted in 861 community-dwelling 70-year-old men and women ( 49 % men ) with complete dietary data from the Prospect i ve Investigation of the Vasculature in Uppsala Seniors ( PIVUS ) . The exposure was dietary acid load as estimated from 7-day food records by the net endogenous acid production ( NEAP ) and potential renal acid load ( PRAL ) algorithms . Renal function assessed by cystatin C estimated glomerular filtration rate was reduced in 21 % of the individuals . Study outcomes were BMD and osteoporosis state ( assessed by DEXA ) and time to fracture ( median follow-up of 9.2 years ) . Results In cross-section , dietary acid load had no significant associations with BMD or with the diagnosis of osteoporosis . During follow-up , 131 fractures were vali date d. Neither NEAP ( adjusted hazard ratios ( HR ) ( 95 % confidence interval ( CI ) ) , 1.01 ( 0.85–1.21 ) , per 1 SD increment ) nor PRAL ( adjusted HR ( 95 % CI ) , 1.07 ( 0.88–1.30 ) , per 1 SD increment ) associated with fracture risk . Further multivariate adjustment for kidney function or stratification by the presence of kidney disease did not modify these null associations . Conclusions The hypothesis that dietary acid load associates with reduced BMD or increased fracture risk was not supported by this study in community-dwelling elderly individuals . Renal function did not influence on this null finding Data on overall  dietary pattern  and osteoporotic fracture risk from population -based cohorts are limited , especially from Asian population s. This study examined the relation between overall diet and hip fracture risk by using principal components analysis ( PCA ) to identify dietary pattern specific to the study population and by using the Alternative Healthy Eating Index ( AHEI ) 2010 to assess dietary quality . The Singapore Chinese Health Study is a prospect i ve population -based cohort that enrolled 63,257 Chinese men and women ( including both pre- and postmenopausal women ) aged 45 - 74 y between 1993 and 1998 in Singapore . Habitual diet was assessed by using a vali date d food-frequency question naire . Two dietary patterns , the vegetable-fruit-soy ( VFS ) pattern and the meat-dim-sum ( MDS ) pattern , were derived by PCA . Overall dietary quality was assessed according to the AHEI 2010 , which was defined a priori for chronic disease prevention . A Cox regression model was applied with adjustment for potential confounders . In both genders , higher scores for the VFS pattern and the AHEI 2010 were associated with lower risk of hip fracture in a dose-dependent manner ( all P-trend ≤ 0.008 ) . Compared with the lowest quintile , participants in the highest quintile had a 34 % reduction in risk ( HR : 0.66 ; 95 % CI : 0.55 , 0.78 ) for the VFS pattern and a 32 % reduction in risk ( HR : 0.68 ; 95 % CI : 0.58 , 0.79 ) for the AHEI 2010 . The MDS pattern score was not associated with hip fracture risk . An Asian diet rich in plant-based foods , namely vegetables , fruit , and legumes such as soy , may reduce the risk of hip fracture A  Western-type diet  is associated with osteoporosis and calcium nephrolithiasis . On the basis of observations that calcium retention and inhibition of bone resorption result from alkali administration , it is assumed that the acid load inherent in this diet is responsible for increased bone resorption and calcium loss from bone . However , it is not known whether the dietary acid load acts directly or indirectly ( i.e. , via endocrine changes ) on bone metabolism . It is also unclear whether alkali administration affects bone resorption/calcium balance directly or whether alkali-induced calcium retention is dependent on the cation ( i.e. , potassium ) supplied with administered base . The effects of neutralization of dietary acid load ( equimolar amounts of NaHCO(3 ) and KHCO(3 ) substituted for NaCl and KCl ) in nine healthy subjects ( 6 men , 3 women ) under metabolic balance conditions on calcium balance , bone markers , and endocrine systems relevant to bone [ glucocorticoid secretion , IGF-1 , parathyroid hormone (PTH)/1,25(OH)(2 ) vitamin D and thyroid hormones ] were studied . Neutralization for 7 days induced a significant cumulative calcium retention ( 10.7 + /- 0.4 mmol ) and significantly reduced the urinary excretion of deoxypyridinoline , pyridinoline , and n-telopeptide . Mean daily plasma cortisol decreased from 264 + /- 45 to 232 + /- 43 nmol/l ( P = 0.032 ) , and urinary excretion of tetrahydrocortisol ( THF ) decreased from 2,410 + /- 210 to 2,098 + /- 190 microg/24 h ( P = 0.027 ) . No significant effect was found on free IGF-1 , PTH/1,25(OH)(2 ) vitamin D , or thyroid hormones . An acidogenic Western diet results in mild metabolic acidosis in association with a state of cortisol excess , altered divalent ion metabolism , and increased bone resorptive indices . Acidosis-induced increases in cortisol secretion and plasma concentration may play a role in mild acidosis-induced alterations in bone metabolism and possibly in osteoporosis associated with an acidogenic Western diet PURPOSE We aim ed to determine whether women consuming fat-free milk versus isoenergetic carbohydrate after resistance exercise  would see augmented gains in lean mass and reductions in fat mass similar to what we observed in young men . METHODS Young women were r and omized to drink either fat-free milk ( MILK : n = 10 ; age ( mean + /- SD ) = 23.2 + /- 2.8 yr ; BMI = 26.2 + /- 4.2 kg x m(-2 ) ) or isoenergetic carbohydrate  ( CON : n = 10 ; age = 22.4 + /- 2.4 yr ; BMI = 25.2 + /- 3.8 kg x m(-2 ) ) immediately after and 1 h after exercise ( 2 x 500 mL ) . Subjects exercised 5 d x wk(-1 ) for 12 wk . Body composition changes were measured by dual-energy x-ray absorptiometry , and subjects ' strength and fasting blood were measured before and after training . RESULTS CON gained weight after training ( CON : + 0.86 + /- 0.4 kg , P < 0.05 ; MILK : + 0.50 + /- 0.4 kg , P = 0.29 ) . Lean mass increased with training in both groups ( P < 0.01 ) , with a greater net gain in MILK versus CON ( 1.9 + /- 0.2 vs 1.1 + /- 0.2 kg , respectively , P < 0.01 ) . Fat mass decreased with training in MILK only ( -1.6 + /- 0.4 kg , P < 0.01 ; CON : -0.3 + /- 0.3 kg , P = 0.41 ) . Isotonic strength increased more in MILK than CON ( P < 0.05 ) for some exercises . Serum 25-hydroxyvitamin D increased in both groups but to a greater extent in MILK than CON ( + 6.5 + /- 1.1 vs + 2.8 + /- 1.3 nM , respectively , P < 0.05 ) , and parathyroid hormone decreased only in MILK ( -1.2 + /- 0.2 pM , P < 0.01 ) . CONCLUSIONS Heavy , whole-body resistance exercise with the consumption of milk versus carbohydrate in the early postexercise period result ed in greater muscle mass accretion , strength gains , fat mass loss , and a possible reduction in bone turnover in women after 12 wk . Our results , similar to those in men , highlight that milk is an effective drink to support favorable body composition changes in women with resistance training Objective : To compare fracture rates in four diet groups ( meat eaters , fish eaters , vegetarians and vegans ) in the Oxford cohort of the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC-Oxford ) . Design : Prospect i ve cohort study of self-reported fracture risk at follow-up . Setting : The United Kingdom . Subjects : A total of 7947 men and 26 749 women aged 20–89 years , including 19 249 meat eaters , 4901 fish eaters , 9420 vegetarians and 1126 vegans , recruited by postal methods and through general practice surgeries .  Methods : Cox regression . Results : Over an average of 5.2 years of follow-up , 343 men and 1555 women reported one or more fractures . Compared with meat eaters , fracture incidence rate ratios in men and women combined adjusted for sex , age and non-dietary factors were 1.01 ( 95 % CI 0.88–1.17 ) for fish eaters , 1.00 ( 0.89–1.13 ) for vegetarians and 1.30 ( 1.02–1.66 ) for vegans . After further adjustment for dietary energy and calcium intake the incidence rate ratio among vegans compared with meat eaters was 1.15 ( 0.89–1.49 ) . Among subjects consuming at least 525 mg/day calcium the corresponding incidence rate ratios were 1.05 ( 0.90–1.21 ) for fish eaters , 1.02 ( 0.90–1.15 ) for vegetarians and 1.00 ( 0.69–1.44 ) for vegans . Conclusions : In this population , fracture risk was similar for meat eaters , fish eaters and vegetarians . The higher fracture risk in the vegans appeared to be a consequence of their considerably lower mean calcium intake . An adequate calcium intake is essential for bone health , irrespective of dietary preferences . Sponsorship : The EPIC-Oxford study is supported by The Medical Research Council and Cancer Research UK Purpose This study aim ed to determine whether there is a relationship between iron status and bone metabolism , and to compare the effects of the consumption , as part of the usual diet , of an iron or iron and vitamin D-fortified skimmed milk on bone remodelling in iron-deficient women . Methods Young healthy iron-deficient or iron-sufficient women ( serum ferritin ≤30 ng/mL or > 30 ng/mL , respectively ) were recruited . Iron-deficient women were assigned to a nutritional intervention consisting of a r and omised , controlled , double-blind , parallel design trial of 16 weeks during winter . They consumed , as part of their usual diet , an iron ( Fe group , n = 54 ) or iron and vitamin D-fortified ( Fe+D group , n = 55 ) flavoured skimmed milk ( iron , 15 mg/day ; vitamin D3 , 5 μg/day , 200 IU ) . The iron-sufficient women followed their usual diet without supplementation ( R group , n = 56 ) . Dietary intake , body weight , iron biomarkers , 25-hydroxyvitamin D ( 25OHD ) , parathyroid hormone ( PTH ) , procollagen-type 1 N-terminal propeptide ( P1NP ) , and aminoterminal telopeptide of collagen I ( NTx ) were determined . Results Negative correlations were found between baseline log-ferritin and log-NTx ( p < 0.001 ) , and between transferrin and P1NP ( p = 0.002 ) . Serum 25OHD increased ( from 62 ± 21 to 71 ± 21 nmol/L , mean ± SD , p < 0.001 ) while P1NP and NTx decreased in Fe+D during the assay ( p = 0.004 and p < 0.001 , respectively ) . NTx was lower in Fe+D compared to Fe at week 8 ( p < 0.05 ) and was higher in Fe and Fe+D compared to R throughout the assay ( p < 0.01 ) . PTH did not show changes . Conclusions Iron deficiency is related with higher bone resorption in young women . Consumption of a dairy product that supplies 5 μg/day of vitamin D3 reduces bone turnover and increases circulating 25OHD to nearly reach an optimal vitamin D status , defined as 25OHD over 75 Although there is some epidemiologic evidence that soy may reduce risk of osteoporotic fracture in women , it is not known whether this risk reduction also occurs for men . The authors examined gender-specific associations between soy intake and hip fracture risk in the Singapore Chinese Health Study , a prospect i ve cohort of 63,257 Chinese living in Singapore . At recruitment between 1993 and 1998 , each subject was administered a food frequency question naire and questions on medical history and lifestyle factors . As of December 31 , 2006 , 276 incident cases of hip fracture in men and 692 cases in women were identified via linkage with hospital discharge data bases . For both genders , hip fracture risk was positively associated with cigarette smoking and was inversely associated with body mass index . There was a statistically significant association of tofu equivalents , soy protein , and isoflavones with hip fracture risk among women but not among men . Compared with women in the lowest quartile of intakes for tofu equivalents ( < 49.4 g/day ) , soy protein ( < 2.7 g/day ) , and isoflavones ( < 5.8 mg/1,000 kcal/day ) , those in the second-fourth quartiles exhibited 21%-36 % reductions in risk ( all P < 0.036 ) . Risk levels were comparable across the second , third , and fourth quartiles of soy intake categories Excess dietary proteins and " acid ash " diets have been suspected to increase the risk of osteoporosis , but experimental and epidemiological evidence is mixed . We aim ed to determine whether the association between protein intake and the overall acid-base equilibrium of the diet ( as renal net acid excretion [ RNAE ] estimate ) and fracture risk vary according to calcium intake . During an average of 8.37 + /- 1.73 yr of follow-up , 2408 women reported a fracture ( excluding high-impact trauma ) among 36,217 postmenopausal women from the E3N prospect i ve study . We used Cox regression models to study the interaction between calcium and , respectively , proteins and RNAE , from the 1993 dietary question naire for fracture risk determination , adjusting for potential confounders . There was no overall association between fracture risk and total protein or RNAE . However , in the lowest quartile of calcium ( < 400 mg/1000 kcal ) , high protein intake was associated with a significant increased fracture risk ( RR = 1.51 for highest versus lowest quartile ; 95 % CI , 1.17 - 1.94 ) . An increasing fracture risk with increasing animal protein intake was also observed ( trend , p < 0.0001 ) . A similar pattern of interaction for fracture risk was observed between RNAE and calcium . In this Western population of postmenopausal women with normal to high protein intake and fairly high calcium intake , there was no overall association between total protein or RNAE and fracture risk . However , there was some evidence that high protein-high acid ash diets were associated with an increased risk of fracture when calcium intake was low ( < 400 mg/1000 kcal ) Dietary guidelines recommend a daily intake of 5 servings of fruits and vegetables . Whether such intakes are associated with a lower risk of hip fracture is at present unclear . The aim of the present study was to investigate the dose-response association between habitual fruit and vegetable intake and hip fracture in a cohort study based on 40,644 men from the Cohort of Swedish Men ( COSM ) and 34,947 women from the Swedish Mammography Cohort ( SMC ) ( total n = 75,591 ) , free from cardiovascular disease and cancer , who answered lifestyle question naires in 1997 ( age 45 to 83 years ) .  Intake of fruits and vegetables  ( servings/day ) was assessed by food frequency question naire and incident hip fractures were retrieved from the Swedish Patient Register ( 1998 to 2010 ) . The mean follow-up time was 14.2 years . One-third of the participants reported an intake of fruits and vegetables  of > 5 servings/day , one-third reported > 3 to ≤5 servings/day , 28 % reported > 1 to ≤3 servings/day , and 6 % reported ≤1 serving/day . During 1,037,645 person-years we observed 3644 hip fractures  ( 2266 or 62 % in women ) . The dose-response association was found to be strongly nonlinear ( p < 0.001 ) . Men and women with zero consumption had 88 % higher rate of hip fracture compared with those consuming 5 servings/day ; adjusted hazard ratio ( HR ) was 1.88 ( 95 % CI , 1.53 to 2.32 ) . The rate was gradually lower with higher intakes ; adjusted HR for 1 versus 5 servings/day was 1.35 ( 95 % CI , 1.21 to 1.58 ) . However , more than 5 servings/day did not confer additionally lower HRs ( adjusted HR for 8 versus 5 servings/day was 0.96 ; 95 % CI , 0.90 to 1.03 ) . Similar results were observed when men and women were analyzed separately . We conclude that there is a dose-response association between fruit and vegetable intake and hip fracture such that an intake below the recommended five servings/day confers higher rates of hip fracture . Intakes above this recommendation do not seem to further lower the risk Summary Eighteen months of daily consumption of milk containing 250 mg calcium prevented bone mineral density ( BMD ) loss at the hip and the femoral neck in postmenopausal Chinese women aged 45 to 65 . Introduction Estrogen-related bone loss in postmenopausal women can be prevented by the consumption of milk with high doses of calcium and soymilk with high doses of isoflavones . However , high doses of calcium and isoflavones may not be necessary to attain a beneficial effect of milk and soymilk on BMD . We hypothesized that BMD will increase in postmenopausal Chinese women who consume daily 250 mg calcium in milk or soymilk . Milk prevented bone loss at the hip and the femoral neck in postmenopausal Chinese women . Methods A total of 141 eligible Chinese women without osteoporosis , aged 45–65 , and postmenopausal for more than 2 years were r and omized into groups receiving for 18 months ( A ) milk with 250 mg calcium daily , ( B ) soymilk with 250 mg calcium daily , or ( C ) neither milk nor soymilk . Dual-energy X-ray absorptiometry measured the BMD of the spine and hip at 0 , 6 , 12 , and 18 months . Results The BMD in the hip ( 2.52 % ) and the femoral neck ( 2.82 % ) of the women consuming milk was significantly higher ( hip , P = 0.01 ; femoral neck , P < 0.0000001 ) . The women in the control group experienced a reduction in BMD at all sites ; the reduction in BMD was only significant at the hip during 12 months ( P = 0.008 ) and at the femoral neck during 18 months ( P = 0.005 ) . Conclusions Daily consumption of milk containing 250 mg calcium over 18 months prevents BMD loss at the hip and the femoral neck in postmenopausal Chinese women CONTEXT It has been assumed that the increase in urine calcium ( Ca ) that accompanies an increase in dietary protein was due to increased bone resorption . However , studies using stable Ca isotopes have found that dietary protein increases Ca absorption without increasing bone resorption . OBJECTIVE The objective of the study was to investigate the impact of a moderately high protein diet on bone mineral density ( BMD ) . DESIGN This was a r and omized , double-blind , placebo-controlled trial of protein supplementation daily for 18 months . SETTING The study was conducted at two institutional research centers . PARTICIPANTS Two hundred eight older women and men with a body mass index between 19 and 32 kg/m(2 ) and a self-reported protein intake between 0.6 and 1.0 g/kg participated in the study . INTERVENTION Subjects were asked to incorporate either a 45-g whey protein or isocaloric maltodextrin supplement into their usual diet for 18 months . MAIN OUTCOME MEASURE BMD by dual-energy x-ray absorptiometry , body composition , and markers of skeletal and mineral metabolism were measured at baseline and at 9 and 18 months . RESULTS There were no significant differences between groups for changes in L-spine BMD ( primary outcome ) or the other skeletal sites of interest . Truncal lean mass was significantly higher in the protein group at 18 months ( P = .048 ) . C-terminal telopeptide ( P = .0414 ) , IGF-1 ( P = .0054 ) , and urinary urea ( P < .001 ) were also higher in the protein group at the end of the study period . There was no difference in estimated glomerular filtration rate at 18 months . CONCLUSION Our data suggest that protein supplementation above the recommended dietary allowance ( 0.8 g/kg ) may preserve fat-free mass without adversely affecting skeletal health or renal function in healthy older adults UNLABELLED In this 2-year r and omized controlled study of 167 men > 50 years of age , supplementation with calcium-vitamin D3-fortified milk providing an additional 1000 mg of calcium and 800 IU of vitamin D3 per day was effective for suppressing PTH and stopping or slowing bone loss at several clinical ly important skeletal sites at risk for fracture . INTRODUCTION Low dietary calcium and inadequate vitamin D stores have long been implicated in age-related bone loss and osteoporosis . The aim of this study was to assess the effects of calcium and vitamin D3 fortified milk on BMD in community living men > 50 years of age . MATERIAL S AND METHODS This was a 2-year r and omized controlled study in which 167 men ( mean age + /- SD , 61.9 + /- 7.7 years ) were assigned to receive either 400 ml/day of reduced fat ( approximately 1 % ) ultra-high temperature ( UHT ) milk containing 1000 mg of calcium plus 800 IU of vitamin D3 or to a control group receiving no additional milk . Primary endpoints were changes in BMD , serum 25(OH)D , and PTH . RESULTS One hundred forty-nine men completed the study . Baseline characteristics between the groups were not different ; mean dietary calcium and serum 25(OH)D levels were 941 + /- 387 mg/day and 77 + /- 23 nM , respectively . After 2 years , the mean percent change in BMD was 0.9 - 1.6 % less in the milk supplementation compared with control group at the femoral neck , total hip , and ultradistal radius ( range , p < 0.08 to p < 0.001 after adjusting for covariates ) . There was a greater increase in lumbar spine BMD in the milk supplementation group after 12 and 18 months ( 0.8 - 1.0 % , p < or = 0.05 ) , but the between-group difference was not significant after 2 years ( 0.7 % ; 95 % CI , -0.3 , 1.7 ) . Serum 25(OH)D increased and PTH decreased in the milk supplementation relative to control group after the first year ( 31 % and -18 % , respectively ; both p < 0.001 ) , and these differences remained after 2 years . Body weight remained unchanged in both groups at the completion of the study . CONCLUSIONS Supplementing the diet of men > 50 years of age with reduced-fat calcium- and vitamin D3-enriched milk may represent a simple , nutritionally sound and cost-effective strategy to reduce  age-related bone loss  at several skeletal sites at risk for fracture in the elderly Acceleration of bone remodelling increases the risk of fragility fractures . The objective of the present study was to explore in elderly women whether a vitamin D and Ca-fortified dairy product providing about 17 - 25 % of the recommended intakes in vitamin D , Ca and proteins would reduce secondary hyperparathyroidism and bone remodelling in a way that may attenuate age-related bone loss in the long term . Thirty-seven institutionalised women , aged 84.8 ( sd 8.1 ) years , with low serum 25-hydroxyvitamin D ( 5.5 ( sd 1.7 ) ng/ml ) were enrolled into a multicentre open trial to consume during 1 month two servings of soft plain cheese made of semi-skimmed milk providing daily 686 kJ ( 164 kcal ) , 2.5 microg vitamin D , 302 mg Ca and 14.2 g proteins . The primary endpoint was the change in serum carboxy terminal cross-linked telopeptide of type I collagen ( CTX ) , selected as a marker of bone resorption . Thirty-five subjects remained compliant . Mean serum changes were : 25-hydroyvitamin D , + 14.5 % ( P = 0.0051 ) ; parathyroid hormone ( PTH ) , - 12.3 % ( P = 0.0011 ) ; CTX , - 7.5 % ( P = 0.01 ) ; tartrate-resistant acid phosphatase isoform 5b ( TRAP 5b ) , - 9.9 % ( P < 0.0001 ) ; albumin , + 6.2 % ( P < 0.0001 ) ; insulin-like growth factor-I (IGF-I),+16.9 % ( P < 0.0001 ) ; osteocalcin , + 8.3 % ( P = 0.0166 ) ; amino-terminal propeptide of type 1 procollagen (P1NP),+19.3 % ( P = 0.0031 ) . The present open trial suggests that fortified soft plain cheese consumed by elderly women with vitamin D insufficiency can reduce bone resorption markers by positively influencing Ca and protein economy , as expressed by decreased PTH and increased IGF-I , respectively . The rise in the bone formation marker P1NP could be explained by a protein-mediated increase in IGF-I. Thus , such a dietary intervention might uncouple , at least transiently , bone resorption from bone formation and thereby attenuate age-related bone loss Summary We examined the independent and combined effects of a multi-component exercise program and calcium – vitamin-D3-fortified milk on bone mineral density ( BMD ) in older men .  Exercise result ed in a 1.8 % net gain in femoral neck BMD , but additional calcium – vitamin D3 did not enhance the response in this group of older well-nourished men . Introduction This 12-month r and omised controlled trial assessed whether calcium – vitamin-D3-fortified milk could enhance the effects of a multi-component exercise program on BMD in older men . Methods Men ( n = 180 ) aged 50–79 years were r and omised into : ( 1 )  exercise + fortified milk ; ( 2 ) exercise ; ( 3 ) fortified milk ; or ( 4 ) controls . Exercise consisted of high intensity progressive resistance training with weight-bearing impact exercise . Men assigned to fortified milk consumed 400 mL/day of low fat milk providing an additional 1,000 mg/day calcium and 800 IU/day vitamin D3 . Femoral neck ( FN ) , total hip , lumbar spine and trochanter BMD and body composition ( DXA ) , muscle strength 25-hydroxyvitamin D and parathyroid hormone ( PTH ) were assessed . Results There were no exercise-by-fortified milk interactions at any skeletal site . Exercise result ed in a 1.8 % net gain in FN BMD relative to no-exercise ( p < 0.001 ) ; lean mass ( 0.6 kg , p < 0.05 ) and muscle strength ( 20–52 % , p < 0.001 ) also increased in response to exercise . For lumbar spine BMD , there was a net 1.4–1.5 % increase in all treatment groups relative to controls ( all p < 0.01 ) . There were no main effects of fortified milk at any skeletal site . Conclusion A multi-component community-based exercise program was effective for increasing FN BMD in older men , but additional calcium – vitamin D3 did not enhance the osteogenic response OBJECTIVE The risk factors for fractures are incompletely understood . An outst and ing question concerns the optimal amount of dietary calcium needed to minimise the risk of fracture . DESIGN We examined the associations of dietary calcium and other nutrients with self-reported fracture risk in a prospect i ve cohort study . Nutrient intakes were estimated using a semi-quantitative food-frequency question naire administered at recruitment . SETTING The UK . PARTICIPANTS A total of 26 749 women and 7947 men aged 20 - 89 years . RESULTS Over an average of 5.2 years of follow-up , 1555 women and 343 men reported one or more fractures , 72 % of these result ing from a fall . Among women , fracture risk was higher at lower calcium intakes , with a relative risk of 1.75 ( 95 % confidence interval ( CI ) 1.33 - 2.29 ) among women with a calcium intake of < 525 mg day- 1 compared with women with a calcium intake of at least 1200 mg day- 1 ( test for linear trend , P < 0.001 ) . The association of  dietary calcium with fracture risk was stronger among women aged under 50 years at recruitment than among women aged 50 and above .  Dietary calcium intake was not associated with fracture risk in men . Fracture risk was not related to the dietary intake of any other nutrient examined . CONCLUSION In this population , women with a low dietary calcium intake had an increased risk of bone fracture , and this association was more marked among younger women than among older women The prevention of increased bone remodeling in postmenopausal women at low 10-y risk of osteoporotic fractures essentially relies on reinforcement of environmental factors known to positively influence bone health , among which nutrition plays an important role . In institutionalized women in their mid-eighties , we previously found that consumption of fortified soft plain cheese increased vitamin D , calcium , and protein intakes , reduced bone resorption biochemical markers , particularly the serum bone specific acid phosphatase tartrate resistant acid phosphatase , isoform 5b ( TRAP 5b ) that reflects osteoclast activity , and stimulated the serum bone anabolic factor insulin-like growth factor-I ( IGF-I ) . Whether these effects occur in much younger women was tested in a prospect i ve control study . Seventy-one healthy postmenopausal women aged 56.6 ± 3.9 y ( mean ± SD ) with low spontaneous supply of both Ca and vitamin D were r and omized to consume daily ( treated , n = 36 ) or not ( controls , n = 35 ) two servings ( 2 × 100 g ) of skimmed-milk , soft plain cheese for 6 wk . The vitamin D and Ca-fortified dairy product provided daily : 661 kJ , 2.5 μg vitamin D , 400 mg calcium , and 13.8 g protein . At the end of the intervention , the decrease in TRAP 5b and the increase in IGF-I were greater in the treated than in the control group ( P < 0.02 ) . The changes in serum carboxy terminal crosslinked telopeptide of type I collagen did not differ significantly between the two groups . In conclusion , like in elderly women , consumption by healthy postmenopausal women of a vitamin D and calcium-fortified dairy product that also increases the protein intake , reduces the serum concentration of the bone resorption biomarker TRAP 5b . This response , combined with the increase in serum IGF-I , is compatible with a nutrition-induced reduction in postmenopausal bone loss rate Although high-protein diets induce hypercalciuria in humans , the source of the additional urinary calcium remains unclear . One hypothesis is that the high endogenous acid load of a high-protein diet is partially buffered by bone , leading to increased skeletal resorption and hypercalciuria . We used dual stable calcium isotopes to quantify the effect of a high-protein diet on calcium kinetics in women . The study consisted of 2 wk of a lead-in , well-balanced diet followed by 10 d of an experimental diet containing either moderate ( 1.0 g/kg ) or high ( 2.1 g/kg ) protein .  Thirteen healthy women received both levels of protein in r and om order . Intestinal calcium absorption increased during the high-protein diet in comparison with the moderate ( 26.2 + /- 1.9 % vs. 18.5 + /- 1.6 % , P < 0.0001 , mean + /- sem ) as did urinary calcium ( 5.23 + /- 0.37 vs. 3.57 + /- 0.35 mmol/d , P < 0.0001 , mean + /- sem ) . The high-protein diet caused a significant reduction in the fraction of urinary calcium of bone origin and a nonsignificant trend toward a reduction in the rate of bone turnover . There were no protein-induced effects on net bone balance . These data directly demonstrate that , at least in the short term , high-protein diets are not detrimental to bone BACKGROUND Calcium is an essential cotherapy in osteoporosis treatment . The relative effectiveness of various calcium salts for this purpose is uncertain . Many older women with osteoporosis have phosphorus intakes of < 70 % of the Recommended Dietary Allowance . OBJECTIVE Our objective was to test the hypothesis that calcium phosphate would better support anabolic bone building than would calcium carbonate . DESIGN This study was a 12-mo , r and omized , positive-comparator , 2-arm , single-blind clinical trial in 211 patients treated with teriparatide who consumed < 1000 mg phosphorus/d . Participants were r and omly assigned to receive , in addition to teriparatide and 1000 IU cholecalciferol , 1800 mg calcium/d as either tricalcium phosphate or calcium carbonate . The primary endpoints were changes in lumbar spine and total hip bone mineral densities ( BMDs ) ; secondary endpoints were changes in bone resorption biomarkers and serum and urine calcium and phosphorus concentrations . RESULTS In the combined group , the lumbar spine BMD increased by 7.2 % , and total hip BMD increased by 2.1 % ( P < 0.01 for both ) . However , there was no significant difference between calcium-treatment groups , and there were no significant between-group differences in serum calcium and phosphorus concentrations or in urine calcium concentrations . Bone resorption biomarkers increased in both groups , as expected with teriparatide , but the increases in the 2 calcium groups did not differ significantly . CONCLUSIONS Tricalcium phosphate and calcium carbonate appear to be approximately equally effective in supporting bone building with a potent anabolic agent ; phosphate salt may be preferable in patients with restricted phosphorus intakes . This trial was registered at clinical trials.gov as NCT00074711 Objective Calcium dem and is increased during pregnancy . However , few r and omized controlled trials examined the effects of calcium supplementation on bone mass during pregnancy . This study determined effects of calcium and milk supplementation on maternal bone mineral density ( BMD ) and bone turnover in pregnant Chinese women with habitual low calcium intake . Methods In this r and omized controlled trial , 36 Chinese pregnant women ( 24–31 years , 18 gestational weeks ) were r and omly assigned to the following three arms ( 12 each ) : I , usual diet ; II , “ I ” + 45 g milk powder ( containing 350 mg calcium ) ; or III , “ II ” + 600 mg calcium/day from gestational age of 20 weeks to 6 weeks post-partum ( PP ) . BMD was measured post-treatment using dual-energy X-ray absorptiometry . Dietary intakes , 24-h urinary calcium , bone resorption ( urinary hydroxyproline ) and formation ( serum osteocalcin ) biomarkers were examined at the gestational age of 20 and 34 weeks , and 6 weeks PP . Results A dose-dependent relationship was observed between calcium intake and BMDs . The BMD values were significantly higher in subjects with calcium and milk supplementation  than those in the controls at the whole body and spine ( p < 0.05 ) but not at the hip sites . We found significant decreases in changes of urinary hydroxyproline , and significant increases in serum osteocalcin during the intervention period in the calcium/milk intervention groups than those in the control group ( all p < 0.05 ) . Conclusion Calcium/milk supplementation during pregnancy is associated with greater BMD at the spine and whole body and suppresses bone resorption in Chinese women with habitual low calcium intake Dietary studies often report low calcium intake amongst post-menopausal Malaysian women and calcium deficiency has been implicated as part of the etiology of age-related bone loss leading to osteoporosis . Therefore , the objective of this study was to examine the effectiveness of high calcium skimmed milk ( Anlene Gold ™ , New Zeal and Milk , Wellington , New Zeal and ) to reduce bone loss in Chinese postmenopausal women . Two hundred subjects aged 55–65 years and who were more than 5 years postmenopausal were r and omized to a milk group and control group . The milk group consumed 50 g of high calcium skimmed milk powder daily , which contained 1200 mg calcium ( taken as two glasses of milk a day ) . The control group continued with their usual diet . Using repeated measures ANCOVA , the milk supplement was found to significantly reduce the percentage of bone loss at the total body compared to the control group at 24 months ( control −1.04 % , milk −0.13 % ; P<0.001 ) . At the lumbar spine , the percentage of bone loss in the control group was significantly higher ( −0.90 % ) when compared to the milk ( −0.13 % ) supplemented group at 24 months ( P<0.05 ) . Similarly , milk supplementation reduced the percentage of bone loss at the femoral neck ( control −1.21 % , milk 0.51 % ) ( P<0.01 ) and total hip ( control −2.17 % , milk −0.50 % ) ( P<0.01 ) . The supplemented group did not experience any significant weight gain over the 24 months . The serum 25-hydroxy vitamin D level improved significantly ( P<0.01 ) from 69.1±16.1 nmol/l at baseline to 86.4±22.0 nmol/l at 24 months in the milk group . In conclusion , ingestion of high calcium skimmed milk was effective in reducing the rate of bone loss at clinical ly important lumbar spine and hip sites in postmenopausal Chinese women in Malaysia . Supplementing with milk had additional benefits of improving the serum 25-hydroxy vitamin D status of the subjects This prospect i ve population -based study assessed predictors of hip fracture risk in white men . Participants were members of the Epidemiologic Follow-up Study cohort of the First National Health and Nutrition Examination Survey , a nationally representative sample of noninstitutionalized civilians who were followed for a maximum of 22 years . A cohort of 2879 white men ( 2249 in the nutrition and weight-loss sub sample , 1437 in the bone density sub sample ) aged 45 - 74 years at baseline ( 1971 - 1975 ) were observed through 1992 . Ninety-four percent of the original cohort were successfully traced . Hospital records and death certificates were used to identify a total of 71 hip fracture cases ( 61 in the nutrition and weight-loss sub sample , 26 in the bone-density sub sample ) . Among the factors evaluated were age at baseline , previous fractures other than hip , body mass index , smoking status , alcohol consumption , nonrecreational physical activity , weight loss from maximum , calcium intake , number of calories , protein consumption , chronic disease prevalence , and phalangeal bone density . The risk adjusted relative risk ( RR ) of hip fracture was significantly associated with presence of one or more chronic conditions ( RR = 1.91 , 95 % confidence interval [ CI ] = 1.19 - 3.06 ) , weight loss from maximum > or = 10 % ( RR = 2.27 , 95 % CI 1.13 - 4.59 ) , and 1 SD change in phalangeal bone density ( RR = 1.73 , 95 % CI 1.11 - 2.68 ) . No other variables were significantly related to hip fracture risk . Although based on a small number of cases , this is one of the first prospect i ve studies to relate weight loss and bone density to hip fracture risk in men BACKGROUND Skeletal loading and proper nutrition are necessary for optimal bone health . The appropriate amount of dietary protein to maximize skeletal health , however , is under constant debate . OBJECTIVE To determine if 6 months of protein supplementation in conjunction with a strength and conditioning training program improves areal and volumetric bone mineral density ( BMD ) . DESIGN Fifty-two apparently healthy males and females ages 18 - 25 years were r and omized to protein supplement ( PRO , Myoplex , EAS , Inc. Golden CO ) containing 280 kcal , 42 g protein , 21 g carbohydrate , and 1.5 g fat ) or calorically equivalent carbohydrate control ( CS ) . All subjects participated in a 5 sessions/week strength and conditioning program .  Volumetric and areal BMD measurements were made by peripheral quantitative computed tomography ( pQCT ) of the tibia and whole body DXA . pSSI a measure of torsional bone strength , based on structural and material properties was obtained by pQCT . RESULTS Measurements at the 20 % tibia by pQCT revealed that overall there were significant increases in cortical vBMD ( 4.3 + /- 1.3 mg/cm(3 ) ) , cortical area ( 1.9 + /- 0.6 cm(2 ) ) , cortical thickness ( 0.05 + /- 0.02 mm ) and pSSI ( 67 + /- 24 mm(3 ) ) , and a decrease in endosteal circumference ( - 0.5 + /- 0.2 mm ) over the intervention period ( all , P < 0.05 ) . None of the changes in DXA measures were found to differ by group or sex , there was a trend for a greater increase in whole body BMC among the carbohydrate compared to protein supplemented group and a greater increase among males ( 16 + /- 8 g ) compared to females ( -9 + /- 9 g ) ( P = 0.06 ) . CONCLUSIONS The results of this study indicate that the consumption of additional protein does not improve measurements of vBMD or bone size during a 6-month strength and conditioning program . Longer duration studies may be necessary to determine the influence of increased dietary protein on bone in young adults . Males and females may have different bone responses to increased protein intake while participating in a strength and conditioning program Summary Association between dietary protein and fracture risk is unclear . We examined association between energy-adjusted protein intake  and  hip fracture risk in elders . The risk of hip fracture was reduced in upper quartiles of protein intake when compared with lowest quartile . Introduction Studies of the association between dietary protein intake and hip fracture risk are conflicting . Therefore , we examined protein intake and hip fracture risk in a population -based group of elderly men and women . Methods Five hundred seventy-six women and 370 men from the Framingham Osteoporosis Study with no previous history of hip fracture completed Food Frequency Question naires .  Energy-adjusted protein intake  was evaluated as a continuous variable and as quartiles . Incidence rates and hazard ratios were calculated , adjusting for age , BMI , sex , and energy intake . Results Among 946 participants ( mean age 75 years ) , mean protein intake  was found to be 68 gm/d . Increased protein intake was associated with a decreased risk of hip fracture compared to those in the lowest quartile of protein intake ( Q2 HR = 0.70 , Q3 HR = 0.56 , and Q4 HR = 0.63 ; all p values ≥ 0.044 ) , p for trend was 0.07 . When a threshold effect was considered ( Q2–4 vs Q1 ) , intakes in the higher quartiles combined were associated with a significantly lower risk for hip fracture ( HR = 0.63 ; p = 0.04 ) . Conclusion Our results are consistent with reduced risk of hip fracture with higher dietary protein intake . Larger prospect i ve studies are needed to confirm and extend this finding in elderly men and women The long-term effects of calcium and vitamin D supplementation on bone material and structural properties in older men are not known . The aim of this study was to examine the effects of high calcium ( 1000 mg/day)- and vitamin-D(3 ) ( 800 IU/day)-fortified milk on cortical and trabecular volumetric BMD ( vBMD ) and bone geometry at the axial and appendicular skeleton in men aged over 50 years . One hundred and eleven men who were part of a larger 2-year r and omized controlled trial had QCT scans  of the mid-femur and lumbar spine ( L(1)-L(3 ) ) to assess vBMD , bone geometry and indices of bone strength [ polar moment of inertia ( I(polar ) ) ] . After 2 years , there were no significant differences between the milk supplementation and control group for the change in any mid-femur or L(1)-L(3 ) bone parameters for all men aged over 50 years . However , the mid-femur skeletal responses to the fortified milk varied according to age , with a split of < or=62 versus > 62 years being the most significant for discriminating the changes between the two groups . Subsequent analysis revealed that , in the older men ( > 62 years ) , the expansion in mid-femur medullary area was 2.8 % ( P < 0.01 ) less in the milk supplementation compared to control group , which helped to preserve cortical area in the milk supplementation group ( between group difference 1.1 % , P < 0.01 ) . Similarly , for mid-femur cortical vBMD and I(polar ) , the net loss was 2.3 and 2.8 % less in the milk supplementation compared to control group ( P < 0.01 and < 0.001 , respectively ) . In conclusion , calcium-vitamin-D(3)-fortified milk may represent an effective strategy to maintain bone strength by preventing endocortical bone loss and slowing the loss in cortical vBMD in elderly men The aim of the present study was to examine whether a holistic approach combining nutrition and lifestyle counselling with the consumption of milk and yoghurt enriched with calcium , vitamin D3 and phylloquinone ( vitamin K1 ) or menaquinone ( vitamin K2 ) would have any additional benefit on bone mineral density ( BMD ) indices measured at various skeletal sites using two different techniques , dual energy X-ray absorptiometry and quantitative ultrasonography ( QUS ) . A sample of 115 postmenopausal women were r and omized to three intervention groups , receiving daily via fortified milk and yoghurt and for 12 months , 800 mg calcium and 10 μg vitamin D3 ( CaD group , n = 26 ) ; 800 mg calcium , 10 μg vitamin D3 and 100 μg vitamin K1 ( CaDK1 group , n = 26 ) ; 800 mg calcium , 10 μg vitamin D3 and 100 μg vitamin K2 ( CaDK2 group , n = 24 ) ; and a control group ( CO group , n = 39 ) following their usual diet . All three intervention groups attended biweekly nutrition and lifestyle counselling sessions . Total BMD significantly increased in all three intervention groups and these changes were significantly higher compared to the CO ( P < 0.001 ) . Furthermore , the significant increases observed for L2–L4 BMD in the CaDK1 and CaDK2 groups were found to be significantly higher compared to the decrease observed in the CO ( P = 0.001 ) . No significant differences were observed for QUS parameters . The combined approach used in the current study led to favourable changes for all three intervention groups in total body BMD , while an additional benefit was observed for L2–L4 BMD in CaDK1 and CaDK2 groups . No significant differences were observed among groups in any of the QUS parameters CONTEXT Protein is an essential component of muscle and bone . However , the acidic byproducts of protein metabolism may have a negative impact on the musculoskeletal system , particularly in older individuals with declining renal function . OBJECTIVE We sought to determine whether adding an alkaline salt , potassium bicarbonate ( KHCO3 ) , allows protein to have a more favorable net impact on intermediary indices of muscle and bone conservation than it does in the usual acidic environment . DESIGN We conducted a 41-d r and omized , placebo-controlled , double-blind study of KHCO3 or placebo with a 16-d phase-in and two successive 10-d metabolic diets containing low ( 0.5 g/kg ) or high ( 1.5 g/kg ) protein in r and om order with a 5-d washout between diets . SETTING The study was conducted in a metabolic research unit . PARTICIPANTS Nineteen healthy subjects ages 54 - 82 yr participated . INTERVENTION KHCO3 ( up to 90 mmol/d ) or placebo was administered for 41 d. MAIN OUTCOME MEASURES We measured 24-h urinary nitrogen excretion , IGF-I , 24-h urinary calcium excretion , and fractional calcium absorption . RESULTS KHCO3 reduced the rise in urinary nitrogen excretion that accompanied an increase in protein intake ( P = 0.015 ) and was associated with higher IGF-I levels on the low-protein diet ( P = 0.027 ) with a similar trend on the high-protein diet ( P = 0.050 ) . KHCO3 was also associated with higher fractional calcium absorption on the low-protein diet ( P = 0.041 ) with a similar trend on the high-protein diet ( P = 0.064 ) . CONCLUSIONS In older adults , KHCO3 attenuates the protein-induced rise in urinary nitrogen excretion , and this may be mediated by IGF-I. KHCO3 may also promote calcium absorption independent of the dietary protein content The dietary acid load created by the typical Western diet may adversely impact the skeleton by disrupting calcium metabolism . Whether neutralizing dietary acid with alkaline potassium salts results in sustained improvements in calcium balance remains controversial . In this r and omized , double-blind , placebo-controlled study , 52 men and women ( mean age 65.2 ± 6.2 years ) were r and omly assigned to potassium citrate 60 mmol/d , 90 mmol/d , or placebo daily with measurements of bone turnover markers , net acid excretion , and calcium metabolism , including intestinal fractional calcium absorption and calcium balance , obtained at baseline and at 6 months . At 6 months , net acid excretion was significantly lower in both treatment groups compared to placebo and it was negative , meaning subjects ' dietary acid was completely neutralized ( -11.3 mmol/d on 60 mmol/d ; -29.5 mmol/d on 90 mmol/d , p < 0.001 compared to placebo ) . At 6 months , 24-hour urine calcium was significantly reduced in persons taking potassium citrate 60 mmol/d ( -46 ± 15.9 mg/d ) and 90 mmol/d ( -59 ± 31.6 mg/d ) compared with placebo ( p < 0.01 ) . Fractional calcium absorption was not changed by potassium citrate supplementation . Net calcium balance was significantly improved in participants taking potassium citrate 90 mmol/d compared to placebo ( 142 ± 80 mg/d on 90 mmol/d versus -80 ± 54 mg/d on placebo ; p = 0.02 ) . Calcium balance was also improved on potassium citrate 60 mmol/d , but this did not reach statistical significance ( p = 0.18 ) . Serum C-telopeptide decreased significantly in both potassium citrate groups compared to placebo ( -34.6 ± 39.1 ng/L on 90 mmol/d , p = 0.05 ; -71.6 ± 40.7 ng/L on 60 mmol/d , p = 0.02 ) whereas bone-specific alkaline phosphatase did not change . Intact parathyroid hormone was significantly decreased in the 90 mmol/d group ( p = 0.01 ) . Readily available , safe , and easily administered in an oral form , potassium citrate has the potential to improve skeletal health . Longer-term trials with definitive outcomes such as bone density and fracture are needed UNLABELLED The role of protein intake in osteoporosis is unclear . In a case-control study in Utah ( n = 2501 ) , increasing level of protein intake was associated with a decreased risk of hip fracture in men and women 50 - 69 years of age but not in those 70 - 89 years of age . Protein intake may be important for optimal bone health . INTRODUCTION Protein is an important component of bone , but the role of dietary protein intake in osteoporosis and fracture risk remains controversial . MATERIAL AND METHODS The role of dietary protein intake in osteoporotic hip fracture was evaluated in a statewide case-control study in Utah . Patients , 50 - 89 years of age , with hip fracture ( cases ) were ascertained through surveillance of 18 Utah hospitals during 1997 - 2001 . Age- and gender-matched controls were r and omly selected . Participants were interviewed in their place of residence , and diet was assessed using a picture-sort food frequency question naire previously reported to give a useful measure of usual dietary intake in the elderly Utah population . The association between  protein intake  and risk of hip fracture was examined across quartiles of protein intake and stratified by age group for 1167 cases ( 831 women , 336 men ) and 1334 controls ( 885 women , 449 men ) . RESULTS In logistic regression analyses that controlled for gender , body mass index , smoking status , alcohol use , calcium , vitamin D , potassium , physical activity , and estrogen use in women , the odds ratios ( OR ) of hip fracture decreased across increasing quartiles of total protein intake for participants 50 - 69 years of age ( OR : 1.0 [ reference ] ; 0.51 [ 95 % CI : 0.30 - 0.87 ] ; 0.53 [ 0.31 - 0.89 ] ; 0.35 [ 0.21 - 0.59 ] ; p < 0.001 ) . No similar associations were observed among participants 70 - 89 years of age . Results from analyses stratified by low and high calcium and potassium intake did not differ appreciably from the results presented above . CONCLUSION Higher total protein intake was associated with a reduced risk of hip fracture in men and women 50 - 69 years of age but not in men and women 70 - 89 years of age . The association between  dietary protein intake  and risk of hip fracture may be modified by age . Our study supports the hypothesis that adequate dietary protein is important for optimal bone health in the elderly 50 - 69 years of age The effects of dietary protein on bone structure and metabolism have been controversial , with evidence for and against beneficial effects . Because no long-term r and omized , controlled studies have been performed , a two-year study of protein supplementation in 219 healthy ambulant women aged 70 to 80 years was undertaken . Participants were r and omized to either a high-protein drink containing 30 g of whey protein ( n = 109 ) or a placebo drink identical in energy content , appearance , and taste containing 2.1 g of protein ( n = 110 ) . Both drinks provided 600 mg of calcium . Dual-energy X-ray absorptiometric ( DXA ) hip areal bone mineral density ( aBMD ) , 24-hour urinary calcium excretion , and serum insulin-like growth factor 1 ( IGF-1 ) were measured at baseline and at 1 and 2 years . Quantitative computed tomographic ( QCT ) hip volumetric bone mineral density ( vBMD ) and a femoral neck engineering strength analysis were undertaken at baseline and at 2 years . Baseline average protein intake was 1.1 g/kg of body weight per day . There was a significant decrease in hip DXA aBMD and QCT vBMD over 2 years with no between-group differences . Femoral neck strength was unchanged in either group over time . The 24-hour urinary calcium excretion increased significantly from baseline in both groups at 1 year but returned to baseline in the placebo group at 2 years , at which time the protein group had a marginally higher value . Compared with the placebo group , the protein group had significantly higher serum IGF-1 level at 1 and 2 years ( 7.3 % to 8.0 % , p < .05 ) . Our study showed that in protein-replete healthy ambulant women , 30 g of extra protein increased IGF-1 but did not have beneficial or deleterious effects on bone mass or strength . The effect of protein supplementation in population s with low dietary protein intake requires urgent attention The Chinese diet is low in calcium ( less than 500 mg/day on average ) , and previous observational studies have suggested an association between a low calcium intake and risk of hip and vertebral fracture . In this study , we r and omly assigned 200 postmenopausal Chinese women ( age range , 55 - 59 years ) to receive 50 g of milk powder containing 800 mg of calcium per day or to a control group . The following are the mean percentage changes ( and SEs ) in height and bone mineral density ( BMD ) over 24 months : for height , -0.1 + /- 0.2 cm in the milk supplementation group and -0.2 + /- 0.1 cm in the control group ; for BMD at the total hip , -0.06 + /- 0.22 % in the milk supplementation group and -0.88 + /- 0.26 % in the control group ; for BMD at the spine ( L1-L4 ) , -0.56 + /- 0.29 % in the milk supplementation group and -1.5 + /- 0.29 % in the control group ; for total body BMD , -0.32 + /- 0.16 % in the milk supplementation group and -1.2 + /- 0.19 % in the control group ( p < 0.05 by analysis of covariance [ ANCOVA ] for repeated measures for height and BMD at all sites ) . The milk supplementation group had less loss in terms of both height and BMD than the control group ( p < 0.05 by ANCOVA for repeated measures ) . Serum parathyroid hormone ( PTH ) concentration was lower and serum 25-hyroxyvitamin D [ 25(OH)D ] level was higher in the milk supplementation group than the control group at 12 months ( p < 0.05 by paired t-test ) . We conclude that supplementing the diet of postmenopausal Chinese women with high calcium milk powder retards bone loss Fracture of the proximal femur is the most dramatic clinical sequela of osteoporosis [ 1 , 2 ] . It is associated with a high mortality rate , need for long-term medical care , and prolonged disability [ 3 - 5 ] . Protein malnutrition is often seen in elderly persons and is more severe in patients with hip fracture [ 6 - 11 ] . Protein deficiency may contribute to the occurrence of hip fracture by reducing muscle strength , impairing movement coordination , and diminishing the protective layer of soft tissue padding [ 9 , 10 , 12 - 14 ] It may also be associated with lower bone mineral density at the proximal femur [ 15 ] . Furthermore , malnutrition in general and protein deficiency in particular at admission and during recovery may adversely influence clinical outcome after hip fracture [ 7 , 9 , 10 , 16 - 18 ] . Protein restriction has been shown to reduce plasma levels of insulin-like growth factor-I ( IGF-I ) by inducing resistance to the action of growth hormone in the liver and increasing the metabolic clearance rate of the growth factor [ 19 - 23 ] . Furthermore , evidence shows that protein depletion may blunt the effect of IGF-I on target organs [ 20 ] . Thus , low protein intake in elderly persons may be detrimental to skeletal integrity , muscle strength , and immune response [ 11 , 24 - 27 ] because of decreased production and action of IGF-I , which favorably influences these systems [ 28 - 33 ] . Previous studies [ 16 , 17 ] have shown that a 5-week course of protein supplements can reduce the medical complication rate and duration of hospital stay in patients with recent hip fracture . These findings were independent of energy , calcium , and vitamin D intake [ 17 ] . Whether these observations were related to the restoration of decreased IGF-I levels and whether bone may benefit from long-term protein supplementation are not known . We investigated whether protein supplements in vitamin D-replete patients with a recent hip fracture who were receiving calcium supplements could increase circulating IGF-I levels and favorably influence bone mineral density . Methods Patients Patients were recruited in the orthopedic ward of Geneva University Hospital , the referral center that receives 94.6 % of all patients with hip fracture from an area with a population of approximately 400 000 persons [ 5 ] . The protocol was approved by the ethical committee of the Geneva University Hospital Department of Surgery . Inclusion criteria were age greater than 60 years ; recent hip fracture ( within 2 weeks ) attributable to osteoporosis ( that is , a fracture after a minor trauma , such as a fall from st and ing height ) ; and the ability to give written , informed consent . Exclusion criteria were pathologic fracture ; fracture caused by severe trauma ; history of contralateral hip fracture ; severe mental impairment ; active metabolic bone disease ; renal failure ( plasma creatinine concentration 200 mol/L ) ; acute illness that could interfere with the study protocol ; severe malnutrition ( serum albumin level < 15 g/L ) ; consumption of drugs known to alter bone metabolism , such as calcitonin , fluoride , sex hormones , corticosteroids , or bisphosphonates ; and life expectancy of less than 1 year . Using a r and om number table , we assigned patients to receive an oral protein supplement composed of 90 % milk proteins or a placebo made isocaloric by the addition of maltodextrins . Patients took the assigned intervention 5 days a week for 6 months in addition to their regular diet . All patients received one oral dose of vitamin D3 , 200 000 IU ( vitamine D3B.O.N. , Doms-Adrian , Courbevoie , France ) , to correct any possible vitamin D deficiency [ 34 ] . The daily protein supplement ( Meritene , S and oz Nutrition Ltd. , Berne , Switzerl and ) provided 1050 kJ ( 250 kcal ) of energy in the form of 20 g of proteins , 3.1 g of lipids , and 35.7 g of carbohydrates ( 54.4 g in placebo ) . The other constituents of the 65 g powder supplement were vitamin A ( 1000 IU ) , vitamin K1 ( 30 g ) , vitamin C ( 20 mg ) , calcium ( 550 mg ) , magnesium ( 91 mg ) , phosphorus ( 429 mg ) , and sodium ( 228 mg ) . The supplement is design ed to normalize but not overcompensate for the insufficient dietary intake of protein of elderly persons with a recent fracture of the proximal femur [ 16 ] . Compliance was verified by weekly phone calls and by counting the remaining nutritional supplement bags , which were forwarded monthly by mail . Clinical Data Medical history , clinical characteristics , anthropometric data , and performance status according to an Activities of Daily Living score [ 35 ] were evaluated . Dietary intakes were recorded by using a food-frequency question naire [ 36 ] about the week before the fracture . Food intakes were analyzed by using a nutrient software system ( Fruitdor , Astra-Calve , Paris , France ) . Dietary intake of calcium , phosphorus , and protein was calculated from intake of dairy products , meat , fish , and vegetables . Because many patients were unable to st and a few days after hip fracture , their height was determined with a fathom measure while they were recumbent . Body weight was determined with a scale that correlated highly with that provided by measurement of whole body bone , fat , and lean mass as assessed by dual x-ray absorptiometry [ 37 ] . Mid-arm circumference was measured with a tape measure ( coefficient of variation , 2 % ) . Isometric muscle strength of the biceps of the dominant arm was evaluated with a dynamometer ( Lido , Lidoactive Isokinetic System , Loredan Biomedical Inc. , West Sacramento , California ) , which measures the peak torque ( coefficient of variation < 5 % ) . The grip strength of the same arm was measured with a dynamometer ( Vigorimeter , Martin Medizin-Technik , Tuttlingen , Germany ) [ 38 ] . The mean of three measurements was used for calculation . Biochemical Data Within 120 hours after surgery , we used st and ard methods to analyze venous blood sample s for protein-corrected plasma levels of calcium , phosphate , creatinine , total proteins , albumin , and prealbumin . We also measured levels of IGF-I ( Nichols Institute , San Juan Capistrano , California ) after acid-ethanol extraction and cryoprecipitation [ 39 ] , intact parathyroid hormone ( Immulite , Diagnostic Products , Los Angeles , California ) , calcitriol , calcidiol ( Incstar , Stillwater , Minnesota ) , and osteocalcin ( CIS-BIO International , Gif-sur-Yvette , France ) . Biochemical measurements were repeated 6 and 12 months after the fracture . Serum IGF-I binding proteins were measured by Western lig and blot analysis [ 40 ] . Briefly , 3 L of serum was boiled and separated onto 15 % sodium dodecylsulfate polyacrilamide gel electrophoresis under nonreducing conditions . Proteins were electrically blotted onto a nitrocellulose membrane , and IGF-I binding proteins were detected after incubating the membranes with radioiodinated IGF-I at 4C for 24 hours . Insulin-like growth factor binding proteins were quantified by phosphorimaging ( Molecular Dynamics , Sunnyvale , California ) . The intensity of the b and s corresponding to the appropriate molecular weights [ 40 ] was expressed as the percentage of total bound radioactive IGF-I. Measurements of calcium , phosphate , and creatinine were obtained from the second fasting morning urine . The ratio of hydroxyproline to creatinine in the same sample was taken as a reflection of bone resorption . Markers of bone resorption ( pyridinoline and deoxypyridinoline ) in the first morning spot urine were measured by detecting fluorescence emission after acid hydrolysis and separation with isocratic reverse-phase high-performance liquid chromatography ( BioRad System , Munich , Germany ) , and the values were adjusted to the creatinine concentration . Immunologic Data Concentrations of IgA , IgG , IgM , and isohemagglutinins were measured by using st and ard methods . Cell-mediated immunity was assessed by using a skin-test antigens for cellular hypersensitivity system ( STACH , Institut Merieux , Lyon , France ) , which evaluates the size of the skin reaction to various antigens injected intradermally [ 41 ] . Bone Mass Assessment We measured areal bone mineral density at the lumbar spine ( anteroposterior and lateral views ) , the contralateral proximal femur ( femoral neck and trochanter ) , and the contralateral mid-femoral shaft . We also measured whole-body bone mineral content , fat , and lean mass by using dual x-ray absorptiometry ( Hologic QDR-2000 , Waltham , Massachusetts ) . The coefficients of variation of these measurements are reported elsewhere [ 37 , 42 ] . Vertebral Deformity Two series of lateral radiography of the thoracic and lumbar spine were taken at the start of the study and at 12 months . The films were examined by a single investigator ( who was unaware of treatment group assignment ) according to a 6-point analysis procedure for each vertebral body from T4 to L4 [ 43 , 44 ] ( intra-observer coefficient of variation , 1.8 % to 3.1 % ) . At baseline , fracture was defined by a decrease of 20 % in the ratio of anterior or middle height to posterior height . Patients were considered to have a new vertebral deformity if the anterior , middle , or posterior height decreased by more than 20 % between the two examinations . Statistical Analysis All values are given as the mean SD for baseline measurement and the mean SE for comparisons of outcome results . All analyses were performed by using the SAS procedure ( Cary , North Carolina ) . One-way analysis of variance was used . A two-tailed P value less than 0.05 was considered significant . Role of the Funding Sources This study was supported by grants from S and oz Nutrition Ltd. , Berne , Switzerl and , and the Swiss National Research Science Foundation . The skin-test antigens for cellular hypersensitivity system was supplied by Rhone-Poulenc , Thalwil , Switzerl and . No organization influenced the design , conduct , or reporting of the study . Results Of 842 patients evaluated from April 1992 to February 1994 , 82 were recruited into the r and omized , double-blind , placebo-controlled trial . This low enrollment rate was due to patients ' poor medical or cognitive conditions and reluctance to give informed consent . BACKGROUND Milk is potentially beneficial for bone health , particularly for Chinese population s where consumption of dairy products is low . There are few data about milk consumption by Chinese women aged 20 - 35 years . This study examines whether milk supplement over 2 years caused increased bone mineral density ( BMD ) in Chinese women aged 20 - 35 years . METHODS Four hundred forty-one community-living women living in Hong Kong SAR ( 221 ) and Beijing ( 220 ) China were r and omized to receive milk supplement or nothing .  The supplement consisted of two sachets of milk powder ( 1000 mg calcium , 80 microg vitamin K(1 ) ) , for 24 months . BMD at total hip , total spine , and whole body was measured at baseline and at 6 , 12 , 18 , and 24 months ; blood specimens were analyzed at baseline and at 3 and 24 months for biochemical indices of bone turnover and vitamin K. Urine sample s also were collected . Analysis was by intention to treat as well as per protocol . Differences in change from baseline between the milk and control groups were analyzed using the mixed models approach to repeated measures , including the baseline value as a covariate . RESULTS Both groups had an increase in BMD and a decrease in bone turnover markers over time , as an indicator of the process of attainment of peak bone mass during this period . Apart from a higher total spine BMD at 6 months in the milk group using per protocol analysis , there was little significant difference observed between the milk group and the control group . CONCLUSIONS Age-related bone metabolism and lack of compliance most likely explain the lack of consistent changes in BMD or bone biochemical measures in response to milk supplementation for 2 years in Chinese women aged 20 - 35 years This study investigated three aspects of general nutritional status ( dietary intake , biochemical markers , and anthropometric measurements )  in relation to subsequent hip fracture risk by using prospect i ve data from the First National Health and Nutrition Examination Survey ( NHANES I ) epidemiologic follow-up studies . A cohort of 2,513 white women 45 years and over who participated in the NHANES I survey in 1971 - 1975 were subsequently followed in the three follow-up studies in 1982 - 1984 , 1986 , and 1987 , respectively . Multiple nutritional variables were measured at baseline , and 130 incident hip fractures were identified by hospital records or by death certificates during the follow-up period . Cox regression analyses showed that baseline dietary energy intake ; serum albumin ; and weight , body mass index , skinfold , and arm muscle area were significantly and inversely related to subsequent hip fracture risk ( relative risks for a 1-st and ard deviation increment in these variables ranged from 0.68 to 0.83 ) . The authors suggest that poor nutritional status , evident in inadequate dietary intake , reduced serum albumin , and decreased body mass and soft tissues , increases the risk for subsequent hip fracture . The study also showed that age and previous fracture history were significant risk factors ; however , self-reported physical activity , parity , and alcohol use were not significantly related to subsequent hip fracture Previously published results from a 2 year r and omized , controlled clinical trial on supplementing the diet of postmenopausal Chinese women with  high-calcium milk powder  ( containing 800 mg of calcium ) showed that bone loss , as measured by bone mineral density ( BMD ) , was prevented . To determine whether the effect of calcium supplementation could be sustained , the study was extended for 1 additional year . According to the intention-to-treat analysis , the differences in the rate of bone loss ( percentage decrease in control group -- percentage decrease in milk supplementation group ) in the third year of the study were : total body BMD , 0.23 % ( 95 % confidence interval [ CI ] 0.07%-0.39 % ) ; total spine BMD , 0.31 % ( 95 % CI - 0.02%-0.65 % ) ; and total hip BMD , 0.44 % ( 95 % CI 0.19%-0.69 % ) . Analysis by the per- protocol method showed a similar effect size . These results indicate that the effects of milk supplementation in preventing  bone loss in postmenopausal Chinese women were sustained after 2 years Almost 30 % of hip fractures occur in men ; the mortality , morbidity , and loss of independence after hip fractures are greater in men than in women . To comprehensively evaluate risk factors for hip fracture in older men , we performed a prospect i ve study of 5994 men , primarily white , age 65 + years recruited at six US clinical centers . During a mean of 8.6 years of 97 % complete follow-up , 178 men experienced incident hip fractures . Information on risk factors including  femoral neck bone mineral density ( FNBMD ) was obtained at the baseline visit . Cox proportional hazards models were used to calculate the hazard ratio ( HR ) with 95 % confidence intervals ; Fine and Gray models adjusted for competing mortality risk . Older age ( ≥75 years ) , low FNBMD , currently smoking , greater height and height loss since age 25 years , history of fracture , use of tricyclic antidepressants , history of myocardial infa rct ion or angina , hyperthyroidism or Parkinson 's disease , lower protein intake , and lower executive function were all associated with an increased hip fracture risk . Further adjustment for competing mortality attenuated HR for smoking , hyperthyroidism , and Parkinson 's disease . The incidence rate of hip fracture per 1000 person-years ( PY ) was greatest in men with FNBMD T-scores < -2.5 ( white women reference data base ) who also had 4 + risk factors , 33.4 . Men age ≥80 years with 3 + major comorbidities experienced hip fracture at rates of 14.52 versus 0.88 per 1000 PY in men age < 70 years with zero comorbidities . Older men with low FNBMD , multiple risk factors , and multimorbidity have a high risk of hip fracture . Many of these assessment s can easily be incorporated into routine clinical practice and may lead to improved risk stratification . © 2016 American Society for Bone and Mineral Research We studied the effects of daily intake of milk basic protein ( MBP ) on radial bone mineral density ( BMD ) in healthy adult women . Thirty-three healthy women were r and omly assigned to a 6-month trial with either placebo or MBP ( 40 mg per day ) . The radial BMD of each volunteer was measured at the beginning of and at six months after the trial . The mean BMD value at the 6th month in the MBP group increased significantly at both 1/6 and 1/10 portion from the distal end of the radius , whereas that in the control group did not . The BMD gain of each volunteer in the MBP group was significantly higher than that in the placebo group . Thus a daily MBP supplementation of 40 mg in healthy adult women can significantly increase radial BMD The acid load accompanying modern diets may have adverse effects on bone and muscle metabolism . Treatment with alkaline salts of potassium can neutralize the acid load , but the optimal amount of alkali is not established . Our objective was to determine the effectiveness of two doses of potassium bicarbonate ( KHCO3 ) compared with placebo on biochemical markers of bone turnover , and calcium and nitrogen ( N ) excretion . In this double-blind , r and omized , placebo-controlled study , 244 men and women age 50 years and older were r and omized to placebo or 1 mmol/kg or 1.5 mmol/kg of KHCO3 daily for 3 months ; 233 completed the study . The primary outcomes were changes in 24-hour urinary N-telopeptide ( NTX ) and N ; changes in these measures were compared across the treatment groups . Exploratory outcomes included 24-hour urinary calcium excretion , serum amino-terminal propeptide of type I procollagen ( P1NP ) , and muscle strength and function assessment s. The median administered doses in the low-dose and high-dose groups were 81 mmol/day and 122 mmol/day , respectively . When compared with placebo , urinary NTX declined significantly in the low-dose group ( p = 0.012 , after adjustment for baseline NTX , gender , and change in urine creatinine ) and serum P1NP declined significantly in the low-dose group ( p = 0.004 , adjusted for baseline P1NP and gender ) . Urinary calcium declined significantly in both KHCO3 groups versus placebo ( p < 0.001 , adjusted for baseline urinary calcium , gender , and changes in urine creatinine and calcium intake ) . There was no significant effect of either dose of KHCO3 on urinary N excretion or on the physical strength and function measures .  KHCO3 has favorable effects on bone turnover and calcium excretion and the lower dose appears to be the more effective dose . Long-term trials to assess the effect of alkali on bone mass and fracture risk are needed BACKGROUND Controversy exists concerning the effects of higher total protein intake ( TPro ) on bone health , which may be associated with reduced bone mineral density ( BMD ) . However , whey protein ( WP ) may induce bone formation because of its basic component , milk basic protein . OBJECTIVE This study assessed the effects of WP supplementation , TPro , and change in TPro ( postsupplementation - presupplementation ) on BMD and bone mineral content ( BMC ; total body , lumbar spine , total femur , and femoral neck ) in overweight and class I obese middle-aged adults following an exercise intervention . METHODS This analysis used data from a double-blind , r and omized , placebo-controlled 36-wk WP supplementation trial , wherein participants consumed a 1.7-MJ ( 400-kcal ) supplement ( 0 , 20 , 40 , or 60 g WP/d ) along with their otherwise unrestricted diet while participating in a resistance and aerobic exercise intervention ( 3 d/wk ) . TPro was the summation of WP and habitual dietary intakes ( 4-d food record ) . Statistical analyses for WP were based on group and bone data [ n = 186 , 108 women ; mean ± SD age : 49 ± 8 y ; body mass index ( BMI ; in kg/m2 ) : 30.1 ± 2.8 ] , whereas TPro was based on dietary and bone data ( n = 113 , 70 women ; age 50 ± 8 y ; BMI 30.1 ± 2.9 ) . RESULTS WP supplementation , regardless of dose , did not influence BMD or BMC following the intervention . By using a multiple linear regression model , TPro ( expressed as g/d or g · kg-1 · d-1 ) and change in TPro ( expressed as g/d ) were not associated with responses over time in total or regional BMD or BMC . By using a cluster analysis approach [ < 1.0 ( n = 41 ) , 1.0 - 1.2 ( n = 28 ) , and ≥1.2 g · kg-1 · d-1 ( n = 44 ) ] , TPro was also not associated with responses in total or regional BMD or BMC over time . CONCLUSION WP supplementation and total dietary protein intake did not negatively or beneficially influence bone quantity in overweight and obese adults during a 9-mo exercise intervention . This trial was registered at clinical trials.gov as NCT00812409 BACKGROUND A previous study on a r and omized controlled trial in 173 postmenopausal Chinese women in Kuala Lumpur showed that milk supplementation was effective to reduce bone loss at the total body , lumbar spine , femoral neck and total hip compared to the control group on a usual diet ( Chee et al. 2003 ) . OBJECTIVE The objective was to determine whether the results were sustained after the conclusion of the study . DESIGN A follow-up study , 18 months after a r and omized controlled trial of milk supplementation was concluded . A total of 139 participants were followed up 21 months after the study ended . Bone mineral density ( BMD ) was measured at the total body , lumbar spine , femoral neck and total hip by dual energy X-ray absorptiometry , and anthropometric measurements as well as changes in dietary habits were measured . RESULTS At the follow-up , the milk supplement group did not show significant bone loss from baseline at most sites ( mean differences + /- SE ) ( total body 0.42 + /- 0.25 % , femoral neck 0.44 + /- 0.58 % , total hip -0.06 + /- 0.46 % ) , unlike the control group ( total body -1.07 + /- 0.28 % p < 0.005 , femoral neck -1.49 + /- 0.56 % p < 0.05 , total hip -0.89 + /- 0.57 % p < 0.05 ) . However , both the milk and control groups showed bone loss from baseline at the lumbar spine ( milk -2.01 % , control -3.29 % , p superior 0.05 ) . The calcium intake of the milk group remained significantly higher than the control group ( milk 710 mg/day , control 466 mg/day , p < 0.005 ) despite discontinuation of the milk supplement . CONCLUSIONS The results showed that some of the beneficial effects of a milk supplement were still evident at follow-up and it was possible to motivate subjects to adopt a positive change in dietary calcium intake after intervention Weight reduction induces bone loss by several factors , and the effect of higher protein ( HP ) intake during caloric restriction on bone mineral density ( BMD ) is not known . Previous study design s examining the longer-term effects of HP diets have not controlled for total calcium intake between groups and have not examined the relationship between bone and endocrine changes . In this r and omized , controlled study , we examined how BMD ( areal and volumetric ) , turnover markers , and hormones [ insulin-like growth factor 1 ( IGF-1 ) , IGF-binding protein 3 ( IGFBP-3 ) , 25-hydroxyvitamin D , parathyroid hormone ( PTH ) , and estradiol ] respond to caloric restriction during a 1-year trial using two levels of protein intake . Forty-seven postmenopausal women ( 58.0 ± 4.4 years ; body mass index of 32.1 ± 4.6 kg/m(2 ) ) completed the 1-year weight-loss trial and were on a higher ( HP , 24 % , n = 26 ) or normal protein ( NP , 18 % , n = 21 ) and fat intake ( 28 % ) with controlled calcium intake of 1.2 g/d . After 1 year , subjects lost 7.0 % ± 4.5 % of body weight , and protein intake was 86 and 60 g/d in the HP and NP groups , respectively . HP compared with NP diet attenuated loss of BMD at the ultradistal radius , lumbar spine , and total hip and trabecular volumetric BMD and bone mineral content of the tibia . This is consistent with the higher final values of IGF-1 and IGFBP-3 and lower bone-resorption marker ( deoxypyridinoline ) in the HP group than in the NP group ( p < .05 ) . These data show that a higher  dietary protein during weight reduction increases serum IGF-1 and attenuates total and trabecular bone loss at certain sites in postmenopausal women CONTEXT The acid load imposed by a modern diet may play an important role in the pathophysiology of osteoporosis . OBJECTIVE Our objective was to evaluate the skeletal efficacy and safety and the effect on fracture prediction of K-citrate to neutralize diet-induced acid loads . DESIGN AND SETTING We conducted a r and omized , double-blind , placebo-controlled trial at a teaching hospital . SUBJECTS Subjects included 201 elderly ( > 65 yr old ) healthy men and women ( t-score of -0.6 at lumbar spine ) . INTERVENTION Intervention was 60 mEq of K-citrate daily or placebo by mouth . All subjects received calcium and vitamin D. OUTCOME MEASURES The primary outcome was change in areal bone mineral density ( aBMD ) at the lumbar spine by dual-energy x-ray absorptiometry after 24 months . Secondary endpoints included changes in volumetric density and microarchitectural parameters by high-resolution peripheral quantitative computed tomography in both radii and both tibiae and fracture risk assessment by FRAX ( Switzerl and ) . RESULTS K-citrate  increased aBMD at lumbar spine from baseline by 1.7 ± 1.5 % [ 95 % confidence interval ( CI ) = 1.0 - 2.3 , P < 0.001 ] net of placebo after 24 months . High-resolution peripheral quantitative computed tomography-measured trabecular densities increased at nondominant tibia ( 1.3 ± 1.3 % , CI = 0.7 - 1.9 , P < 0.001 ) and nondominant radius ( 2.0 ± 2.0 % , CI = 1.4 - 2.7 , P < 0.001 ) . At nondominant radius , trabecular bone volume/tissue volume increased by 0.9 ± 0.8 % , ( CI = 0.1 - 1.7 ) , trabecular thickness by 1.5 ± 1.6 % ( CI = 0.7 - 2.3 ) , and trabecular number by 1.9 ± 1.8 % ( CI = 0.7 - 3.1 , for all , P < 0.05 ) . K-citrate  diminished fracture prediction score by FRAX significantly in both sexes . CONCLUSIONS Among a group of healthy elderly persons without osteoporosis , treatment with K-citrate for 24 months result ed in a significant increase in aBMD and volumetric BMD at several sites tested , while also improving bone microarchitecture . Based on the effect on fracture prediction , an effect on future fractures by K-citrate is possible
target: In older people with osteoporosis , higher protein intake ( ≥ 0.8-g/kg body weight/day , i.e. , above the current RDA ) is associated with higher BMD , a slower rate of bone loss , and reduced risk of hip fracture , provided that dietary calcium intakes are adequate .
  Intervention with dietary protein supplements attenuate age-related BMD decrease and reduce bone turnover marker levels , together with an increase in IGF-I and a decrease in PTH .
  There is no evidence that diet-derived acid load is deleterious for bone health .
  Thus , insufficient dietary protein intakes may be a more severe problem than protein excess in the elderly .
background: A summary of systematic review s and meta-analyses addressing the benefits and risks of dietary protein intakes  for  bone health in adults suggests that dietary protein levels even above the current RDA may be beneficial in reducing bone loss and hip fracture risk , provided calcium intakes are adequate .
  Several systematic review s and meta-analyses have addressed the benefits and risks of dietary protein intakes for bone health in adults .
  Adequate supplies of dietary protein are required for optimal bone growth and maintenance of healthy bone .
  Variation in protein intakes within the “ normal ” range accounts for 2–4 % of BMD variance in adults .