Low Protein Intake: The Impact on Calcium and Bone Homeostasis in Humans
Open accessAbstract
Increasing dietary protein results in an increase in urinary calcium. Despite over 80 y of research, the source of the additional urinary calcium remains unclear. Because most calcium balance studies found little effect of dietary protein on intestinal calcium absorption, it was assumed that the skeleton was the source of the calcium. The hypothesis was that the high endogenous acid load generated by a protein-rich diet would increase bone resorption and skeletal fracture. However, there are no definitive nutrition intervention studies that show a detrimental effect of a high protein diet on the skeleton and the hypothesis remains unproven. Recent studies from our laboratory demonstrate that dietary protein affects intestinal calcium absorption. We conducted a series of short-term nutrition intervention trials in healthy adults where dietary protein was adjusted to either low, medium or high. The highest protein diet resulted in hypercalciuria with no change in serum parathyroid hormone. Surprisingly, within 4 d, the low protein diet induced secondary hyperparathyroidism that persisted for 2 wk. The secondary hyperparathyroidism induced by the low protein diet was attributed to a reduction in intestinal calcium absorption (as assessed by dual stable calcium isotopes). The long-term consequences of these low protein-induced changes in calcium metabolism are not known, but they could be detrimental to skeletal health. Several recent epidemiological studies demonstrate reduced bone density and increased rates of bone loss in individuals habitually consuming low protein diets. Therefore, studies are needed to determine whether low protein intakes directly affect rates of bone resorption, bone formation or both.
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Older persons are at a higher risk for inadequate protein intake than their younger counterparts.
“Epidemiological data indicate that older persons are at a higher risk for inadequate protein intake than their younger counterparts [7].”
From Novel Insights on Intake of Fish and Prevention of Sarcopenia: All Reasons for an Adequate Consumption (2020) · cites this paper as [7]
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- Authors
- Kerstetter, J. E., O'Brien, K. O., & Insogna, K. L.
- Affiliations
- University of Connecticut (US)
- Johns Hopkins University (US)
- Yale University (US)
- Corresponding author
- Kerstetter, Jane E.
- Venue
- The Journal of Nutrition
- Publisher
- Elsevier BV
- Published
- 2003-03
- Volume
- 133
- Issue
- 3
- Pages
- 855S-861S
- ISSN
- 0022-3166 (ISSN-L)
- OpenAlex
- W2139462080
- Cited by
- 212
- References
- 70
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 3 · 2022: 6 · 2021: 4 · 2020: 8 · 2019: 10 · 2018: 4 · 2017: 10 · 2016: 9 · 2015: 11 · 2014: 14 · 2013: 11 · 2012: 18
- FWCI
- 2.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (DK52128-03, R01DK052128)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (5P30AR46032-04, P30AR046032)
- National Center for Research Resources (M01RR000125, M01 RR-00125)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Health Sciences › Medicine › Nephrology › Renal function and acid-base balance
- Keywords
- low-protein diet, dietary protein, calcium homeostasis, bone homeostasis, hypercalciuria, secondary hyperparathyroidism, intestinal calcium absorption, bone resorption, bone loss, bone mineral density, acid load, parathyroid hormone
- MeSH terms
- Adult, Bone and Bones, Bone Resorption, Calcium, Calcium, Dietary, Female, Homeostasis, Humans, Hyperparathyroidism, Intestinal Absorption, Male, Osteoporosis, Bone Density, Diet, Protein-Restricted
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