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Acid-alkaline balance and bone health: research articles of special interest

by Dr. Susan E. Brown, PhD

The resources listed below represent a collection of scientific articles discussing research on the effects of chronic, low-grade metabolic acidosis on bone, including studies relating acid-base balance to osteopenia and osteoporosis. These sources represent an expanding database of observations that support pH balance as a necessary component of full bone health.

Abelow, B. J. et al. 1992 Cross-cultural association between dietary animal protein and hip fracture: A hypothesis. Calcif Tiss Int 50:14–18.

Alexy, U., T. Remer, et al. (2005). Long-term protein intake and dietary potential renal acid load are associated with bone modeling and remodeling at the proximal radius in healthy children. Am J Clin Nutr 82:1107-14.

Amanzadeh, J., Gitomer, W.L., et al. (2003). Effect of high protein diet on stone-forming propensity and bone loss in rats. Kidney Int 64(6): 2142-9. PMID: 14633136

Arnett, T. R. and D. W. Dempster. 1986. Effect of pH on bone resorption by rat osteoclasts in vitro. Endocrin 119:119–124.

Arnett, T. (2003). Regulation of bone cell function by acid-base balance. Proc Nutr Soc 62(2): 511-20. PMID: 14506899

Arnett, T. R., Spowage, M. (1996). Modulation of the resorptive activity of rat osteoclasts by small changes in extracellular pH near the physiological range. Bone 18(3): 277-9. PMID: 8703584

Bäckman, T. (1999). Acid-base balance, dentinogenesis, and dental caries. Faculty of Medicine, University of Oulu, Finland.

Ballard, T. L., Clapper, J.A., et al. (2005). Effect of protein supplementation during a 6-mo strength and conditioning program on insulin-like growth factor I and markers of bone turnover in young adults. Am J Clin Nutr 81(6): 1442-8. PMID: 15941900

Barzel, U.S., Jowsey, J. (1969). The effects of chronic acid and alkali administration on bone turnover in adult rats. Clin Sci 36(3): 517-24. PMID: 5795240

Barzel, U.S., Massey, L.K. (1998). Excess dietary protein can adversely affect bone. J Nutr 128(6): 1051-3. PMID: 9614169

Brandao-Burch, A., J.C. Utting, I.R. Orriss, et al. (2005). Acidosis inhibits bone formation by osteoblasts in vitro by preventing mineralization. Calcif Tissue Int 77: 167-174.

Breslau, N.A., Brinkley, L., et al. (1988). Relationship of animal protein-rich diet to kidney stone formation and calcium metabolism. J Clin Endocrinol Metab 66(1): 140-6. PMID: 2826524

Buclin, T., Cosma, M., et al. (2001). Diet acids and alkalis influence calcium retention in bone. Osteoporos Int 12(6): 493-9. PMID: 11446566

Budde, R.A., Crenshaw, T.D. (2003). Chronic metabolic acid load induced by changes in dietary electrolyte balance increased chloride retention but did not compromise bone in growing swine. J Anim Sci 81(1): 197-208. PMID: 12597391

Burket, J. C., J. MacLeay, et al. (2010). Variations in cancellous bone tissue composition and mechanical properties with a model of osteoporosis and treatment in sheep. Presentation number SU0048, ASBMR Conference, Toronto, Canada.

Bushinsky, D.A. (1987). Effects of parathyroid hormone on net proton flux from neonatal mouse calvariae. Am J Physiol 252(4 Pt 2): F585-9. PMID: 3031997

Bushinsky, D.A. (1989). Internal exchanges of hydrogen ions: bone. In: Seldein D.W., Giebisch, G., eds. The regulation of acid-base balance. New York: Raven Press, pp. 69-88.

Bushinsky, D.A. (1995). Stimulated osteoclastic and suppressed osteoblastic activity in metabolic but not respiratory acidosis. Am J Physiol 268(1 Pt 1): C80-8. PMID: 7840163

Bushinsky, D.A. (1996). Metabolic alkalosis decreases bone calcium efflux by suppressing osteoclasts and stimulating osteoblasts. Am J Physiol 271(1 Pt 2): F216-22. PMID: 8760264

Bushinsky, D.A. (2001). Acid-base imbalance and the skeleton. Eur J Nutr 40(5): 238-44. http://www.saeure-basen-forum.de/pdf/symp2001/bushinsky.pdf

Bushinsky, D.A., Coe, F.L. (1985). Hyperkalemia during acute ammonium chloride acidosis in man. Nephron 40(1): 38-40. PMID: 3923378

Bushinsky, D.A., Gavrilov, K., et al. (1997). Effect of metabolic acidosis on the potassium content of bone. J Bone Miner Res 12(10): 1664-71. PMID: 9333127

Bushinsky, D.A., Gavrilov, K., et al. (1996). Effects of osteoclastic resorption on bone surface ion composition. Am J Physiol 271(4 Pt 1): C1025-31. PMID: 8897806

Bushinsky, D.A., Krieger, N.S., et al. (1983). Effects of pH on bone calcium and proton fluxes in vitro. Am J Physiol 245(2): F204-9. PMID: 6881337

Bushinsky, D.A., Lechleider, R.J. (1987). Mechanism of proton-induced bone calcium release: calcium carbonate-dissolution. Am J Physiol 253(5 Pt 2): F998-1005. PMID: 2825542

Bushinsky, D.A., Levi-Setti, R., et al. (1986). Ion microprobe determination of bone surface elements: effects of reduced medium pH. Am J Physiol 250(6 Pt 2): F1090-7. PMID: 3717349

Bushinsky, D.A., Nilsson, E.L. (1995). Additive effects of acidosis and parathyroid hormone on mouse osteoblastic and osteoclastic function. Am J Physiol 269(6 Pt 1): C1364-70. PMID: 8572164

Bushinsky, D.A., Sessler, N.E. (1992). Critical role of bicarbonate in calcium release from bone. Am J Physiol 263(3 Pt 2): F510-5. PMID: 1415579

Bushinsky, D.A., Sessler, N.E., et al. (1994). Proton-induced physicochemical calcium release from ceramic apatite disks. J Bone Miner Res 9(2): 213-20. PMID: 8140934

Bushinsky, D.A., Sessler, N.E., et al. (1992). Greater unidirectional calcium efflux from bone during metabolic, compared with respiratory, acidosis. Am J Physiol 262(3 Pt 2): F425-31. PMID: 1558159

Bushinsky, D.A., Smith, S.B., et al. (2002). Acute acidosis-induced alteration in bone bicarbonate and phosphate. Am J Physiol Renal Physiol 283(5): F1091-7. PMID: 12372785

Bushinsky, D.A., Smith, S.B., et al. (2003). Chronic acidosis-induced alteration in bone bicarbonate and phosphate. Am J Physiol Renal Physiol 285(3): F532-9. PMID: 12759230

Canas, F., Terepka, A.R., et al. (1969). Potassium and milieu interieur of bone. Am J Physiol 217(1): 117-20. PMID: 5785866

Carter, J.D., Vasey, F.B., et al. (2006). The effect of a low-carbohydrate diet on bone turnover. Osteoporos Int 17(9): 1398-403. PMID: 16718399

Cochran, M., Wilkinson, R. (1975). Effect of correction of metabolic acidosis on bone mineralisation rates in patients with renal osteomalacia. Nephron 15: 98-110.

Dargent-Molina, P., S. Sabia, et al. (2008). Proteins, dietary acid load, and calcium and risk of post-menopausal fractures in the E3N French Women Prospective Study. J Bone Miner Res 23(12):1915-22.

Dawson-Hughes, B., S.S. Harris, N.J. Palermo, et al. (2009). Treatment with potassium bicarbonate lowers calcium excretion and bone resorption in older men and women. J Clin Endocrinol Metab 94: 96-102.

Dawson-Hughes, B., Harris, S.S., et al. (2008). Alkaline diets favor lean tissue mass in older adults. Am J Clin Nutr 87(3): 662-5. PMID: 18326605

Dawson-Hughes, B., Harris, S.S., et al. (2004). Effect of dietary protein supplements on calcium excretion in healthy older men and women. J Clin Endocrinol Metab 89(3): 1169-73. PMID: 15001604

Dawson-Hughes, B., Harris, S.S. (2002). Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Am J Clin Nutr 75(4): 773-779. ID: 11916767

Devine, A., Prince, R.L., et al. (1996). Nutritional effect of calcium supplementation by skim milk powder or calcium tablets on total nutrient intake in postmenopausal women. Am J Clin Nutr 64(5): 731-7. PMID: 8901793

Domrongkitchaiporn, S., Pongsakul, C., et al. (2001). Bone mineral density and histology in distal renal tubular acidosis. Kidney Int 59(3): 1086-93. PMID: 11231364

Domrongkitchaiporn, S., Pongsakul, C., et al. (2002). Bone histology and bone mineral density after correction of acidosis in distal renal tubular acidosis. Kidney Int 62(6): 2160-6. PMID: 12427141

Duff, T.L., Whiting, S.J. (1998). Calciuric effects of short-term dietary loading of protein, sodium chloride and potassium citrate in prepubescent girls. J Am Coll Nutr 17(2): 148-54. PMID: 9550458

Fenton, T.R., A.W. Lyon, M. Eliaziw, et al. (2009). Meta-analysis of the effect of the acid-ash hypothesis of osteoporosis on calcium balance. J Bone Miner Res 24: 1835-1840.

Fenton, T. R., A. W. Lyon, M. Eliasziw, et al. (2009). Phosphate decreases urine calcium and increases calcium balance: A meta-analysis of the osteoporosis acid-ash diet hypothesis. Nutr J 8:41.

Fenton, T. R., M. Eliasziw, et al. (2010). Bone fractures or the loss of bone mineral density: A prospective cohort study. BMC Musculo Dis 11:88.

Frassetto, L., R.C. Morris Jr., and A. Sebastian. (1997). Potassium bicarbonate reduces urinary nitrogen excretion in postmenopausal women. J Clin Endocrinol Metab 82: 254-259.

Frassetto, L., R.C. Morris, Jr. and A. Sebastian. (2004). Diet acid load and bone health. In Nutritional Aspects of Osteoporosis, 2nd ed. Ed. P. Burckhardt, B. Dawson-Hughes and R.P. Heaney. San Diego, CA: Elsevier Academic Press.

Frassetto, L., Morris, R.C. Jr., et al. (1997). Potassium bicarbonate reduces urinary nitrogen excretion in postmenopausal women. J Clin Endocrinol Metab 82(1): 254-9.

Frassetto, L., Morris, R.C. Jr., et al. (2005). Long-term persistence of the urine calcium-lowering effect of potassium bicarbonate in postmenopausal women. J Clin Endocrinol Metab 90(2): 831-4. PMID: 15572425

Frassetto, L., Sebastian, A. (1996). Age and systemic acid-base equilibrium: analysis of published data. J Gerontol A Biol Sci Med Sci 51(1): B91-9. PMID: 8548506

Frassetto, L.A., Morris, R.C. Jr., et al. (1996). Effect of age on blood acid-base composition in adult humans: role of age-related renal functional decline. Am J Physiol 271(6 Pt 2): F1114-22.

Frassetto, L.A., Nash, E., et al. (2000). Comparative effects of potassium chloride and bicarbonate on thiazide-induced reduction in urinary calcium excretion. Kidney Int 58(2): 748-52. PMID: 10916098

Frassetto, L.A., Todd, K.M., et al. (1998). Estimation of net endogenous noncarbonic acid production in humans from diet potassium and protein contents. Am J Clin Nutr 68(3): 576-83. PMID: 9734733

Frassetto, L.A., Todd, K.M., et al. (2000). Worldwide incidence of hip fracture in elderly women: relation to consumption of animal and vegetable foods. J Gerontol Biol Sci Med Sci 55(10): M585-92. PMID: 11034231

Frick, K.K., Bushinsky, D.A. (1998). Chronic metabolic acidosis reversibly inhibits extracellular matrix gene expression in mouse osteoblasts. Am J Physiol 275(5 Pt 2): F840-7. PMID: 9815143

Frick, K.K., Bushinsky, D.A. (2003). Metabolic acidosis stimulates RANKL RNA expression in bone through a cyclo-oxygenase-dependent mechanism. J Bone Miner Res 18(7): 1317-25. PMID: 12854843

Frings-Meuthen, P., N. Baecker, and M. Heer. (2008). Low-grade metabolic acidosis may be the cause of sodium-chloride induced exaggerated bone resorption. J Bone Miner Res 23: 517-524.

Green, J., Kleeman C.R. (1991). The role of bone in the regulation of systemic acid-base balance. Contrib Nephrol 91: 61-76. PMID: 1800012

Grinspoon, S.K., Baum, H.B., et al. (1995). Decreased bone formation and increased mineral dissolution during acute fasting in young women. J Clin Endocrinol Metab 80(12): 3628-33. PMID: 8530611

Grinspoon, S.K., Baum, H.B., et al. (1995). Decreased bone formation and increased mineral dissolution during acute fasting in young women. J Clin Endocrinol Metab 80(12): 3628-33. PMID: 8530611

Hardcastle, A. C., L. Aucott, et al. (2011). Dietary patterns, bone resorption and bone mineral density in early post-menopausal Scottish women. Eur J Clin Nutr 65:378-85.

Heaney, R., Weaver, C., et al. (1993). Absorbability of calcium from brassica vegetables: broccoli, bok choy, and kale. J Food Sci 58(6): 1378-80.

Heersche, J.N., Bellows, C.G., et al. (1998). The decrease in bone mass associated with aging and menopause. J Prosthet Dent 79(1): 14-6. PMID: 9474535

Hegarty, V.M., May, H.M., et al. (2000). Tea drinking and bone mineral density in older women. Am J Clin Nutr 71(4): 1003-7. PMID: 10731510

Henriksen, K., Sorensen, M.G., et al. (2006). Degradation of the organic phase of bone by osteoclasts: a secondary role for lysosomal acidification. J Bone Miner Res 21(1): 58-66. PMID: 16355274

Hood, V.L., Tannen, R. L. (1998). Protection of acid-base balance by pH regulation of acid production. N Engl J Med 339(12): 819-26. PMID: 9738091

Hu, J. F., Zhao, X.H., et al. (1993). Dietary intakes and urinary excretion of calcium and acids: a cross-sectional study of women in China. Am J Clin Nutr 58(3): 398-406. PMID: 8237852

Jaffe, R. and S. E. Brown. 2000. Acid alkaline balance and its effect on bone health. Int. J. Integ. Med. 2(6).

Jajoo, R., Song, L., et al. (2006). Dietary acid-base balance, bone resorption, and calcium excretion. J Am Coll Nutr 25(3): 224-30. PMID: 16766781

Jehle, S., Zanetti, A., et al. (2006). Partial neutralization of the acidogenic Western diet with potassium citrate increases bone mass in postmenopausal women with osteopenia. J Am Soc Nephrol 17(11): 3213-22. PMID: 17035614

Kalhoff, H., Manz, F. (2001). Nutrition, Acid-Base Status and Growth in Early Childhood. Eur J Nutr 40(5): 221-30. http://www.saeure-basen-forum.de/pdf/symp2001/kalhoff_manz.pdf

Kerstetter, J. E., Mitnick, M.E., et al. (1999). Changes in bone turnover in young women consuming different levels of dietary protein. J Clin Endocrinol Metab 84(3): 1052-5. PMID: 10084594

Klevay, L. M., Wildman, R.E. (2002). Meat diets and fragile bones: inferences about osteoporosis. J Trace Elem Med Biol 16(3): 149-54. PMID: 12437150

Kocian, J., Brodan, V. (1979). Simultaneous correction of Ca deficiency and acidosis in fasting obese patients as a prevention of bone demineralisation. Nutr Metab 23(5): 391-8. PMID: 481830

Komarova, S.V., Pereverzev, A., et al. (2005). Convergent signaling by acidosis and receptor activator of NF-kappaB ligand (RANKL) on the calcium/calcineurin/NFAT pathway in osteoclasts. Proc Natl Acad Sci U S A 102(7): 2643-8. PMID: 15695591

Krieger, N. S., Frick, K.K., et al. (2002). Cortisol inhibits acid-induced bone resorption in vitro. J Am Soc Nephrol 13(10): 2534-9. PMID: 12239242

Krieger, N. S., Sessler, N.E., et al. (1992). Acidosis inhibits osteoblastic and stimulates osteoclastic activity in vitro. Am J Physiol 262(3 Pt 2): F442-8. PMID: 1558161

Krieger, N. S., Sukhatme, V.P., et al. (1990). Conditioned medium from ras oncogene-transformed NIH 3T3 cells induces bone resorption in vitro. J Bone Miner Res 5(2): 159-64. PMID: 2180257

Krieger, N, S. Yee, et al. (2009). Metabolic acidosis stimulates RGS2 and inhibits RGS16 in osteoblasts. Presentation number SU0208, ASBMR 31st Annual Meeting, Colorado.

Kurtz, I., Maher, T. et al. (1983). Effect of diet on plasma acid-base composition in normal humans. Kidney Int 24(5): 670-80. PMID: 6663989

Lacey, J. M., J. J., erson, et al. (1991). Correlates of cortical bone mass among premenopausal and postmenopausal Japanese women. J Bone Miner Res 6(7): 651-9. PMID: 1950670

Lanham-New, S. (2008). The balance of bone health: Tipping the scales in favor of potassium-rich, bicarbonate-rich foods. J Nutr 138: 172S-177S.

Lau, K., Wolf, C., et al. (1979). Differing effects of acid versus neutral phosphate therapy of hypercalciuria. Kidney Int 16(6): 736-42. PMID: 44888

Lemann, J., Jr., Adams, N.D., et al. (2000). Acid and mineral balances and bone in familial proximal renal tubular acidosis. Kidney Int 58(3): 1267-77. PMID: 10972690

Lemann, J., Jr., Bushinsky, D.A., et al. (2003). Bone buffering of acid and base in humans. Am J Physiol Renal Physiol 285(5): F811-32. PMID: 14532161

Lemann, J., Jr., Gray, R.W. et al. (1986). The importance of renal net acid excretion as a determinant of fasting urinary calcium excretion. Kidney Int 29(3): 743-6. PMID: 3702225

Lemann, J., Jr., Litzow, J.R., et al. (1966). The effects of chronic acid loads in normal man: further evidence for the participation of bone mineral in the defense against chronic metabolic acidosis. J Clin Invest 45(10): 1608-14. PMID: 5927117

Lemann, J., Jr., Pleuss, J.A., et al. (1993). Potassium causes calcium retention in healthy adults. J Nutr 123(9): 1623-6. PMID: 8360791

Lemann, J., Jr., Pleuss, J.A., et al. (1991). Potassium administration reduces and potassium deprivation increases urinary calcium excretion in healthy adults [corrected]. Kidney Int 39(5): 973-83. PMID: 1648646

Lennon, E.J., Lemann, J. Jr., et al. (1966). The effects of diet and stool composition on the net external acid balance of normal subjects. J Clin Invest 45(10): 1601-7. PMID: 5925517

Lewis, N.M., Marcus, M.S., et al. (1989). Calcium supplements and milk: effects on acid-base balance and on retention of calcium, magnesium, and phosphorus. Am J Clin Nutr 49(3): 527-33. PMID: 2923085

Licata, A.A., Bou, E., et al. (1981). Acute effects of dietary protein on calcium metabolism in patients with osteoporosis. J Gerontol 36(1): 14-9. PMID: 7451829

Lin, P.H., Ginty, F., et al. (2003). The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults. J Nutr 133(10): 3130-6. PMID: 14519796

MacDonald, H.M., New, S.A., et al. (2005). Low dietary potassium intakes and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal women and increased markers of bone resorption in postmenopausal women. Am J Clin Nutr 81(4): 923-33. PMID: 15817873

MacDonald, H.M., New, S.A., et al. (2004). Nutritional associations with bone loss during the menopausal transition: Evidence of a beneficial effect of calcium, alcohol, and fruit and vegetable nutrients and of a detrimental effect of fatty acids. Am J Clin Nutr. 79: 155-65

Manz, F. (2001). History of nutrition and acid-base physiology. Eur J Nutr 40(5): 189-99. http://www.saeure-basen-forum.de/pdf/symp2001/manz.pdf

Marangella, M., M. Di Stefano, et al. (2004). Effects of potassium citrate supplementation on bone metabolism. Calcif Tissue Int 74(4): 330-5. PMID: 15255069

Massey, L. K., Whiting S.J. (1996). Dietary salt, urinary calcium, and bone loss. J Bone Miner Res 11(6): 731-6. PMID: 8725169

Maurer, M., W. Riesen, J. Muser, H. N. Hulter, R. Krapf. (2003). Neutralization of western diet inhibits bone resorption independently of K intake and reduces cortisol secretion in humans. Am J Physiol Renal Physiol 284: F32-F40.

May, R.C., Kelly, R.A., et al. (1986). Metabolic acidosis stimulates protein degradation in rat muscle by a glucocorticoid-dependent mechanism. J Clin Invest 77(2): 614-21. PMID: 3511100

McGartland, C.P., Robson, P.J., et al. (2004). Fruit and vegetable consumption and bone mineral density: the Northern Ireland Young Hearts Project. Am J Clin Nutr 80(4): 1019-23. PMID: 15447914

McLean, R. R., N. Qiao, et al. (2011). Dietary acid load is not associated with lower bone mineral density except in older men. J Nutr 141:588-94.

McTieran, A., J. Wactawski-Wende, et al. (2009). Low-fat, increased fruit, vegetable, and grain dietary pattern, fractures, and bone mineral density: The Women’s Health Initiative Dietary Modification Trial. Am J Clin Nutr 89(6):1864-76.

Meghji, S., Morrison, M.S., et al. (2001). pH dependence of bone resorption: mouse calvarial osteoclasts are activated by acidosis. Am J Physiol Endocrinol Metab 280(1): E112-9. PMID: 11120665

Melton, L., Therneau, T., et al. (1998). Long-term trends in hip fracture prevalence: The Influence of hip fracture incidence and survival. Osteoporos Int 8(1): 68-74.

Michaud, D.S., Troiano, R.P., et al. (2003). Comparison of estimated renal net acid excretion from dietary intake and body size with urine pH. J Am Diet Assoc 103(8): 1001-7; discussion 1007. PMID: 12891148

Minich, D.M., Bland, J.S. (2007). Acid-alkaline balance: role in chronic disease and detoxification. Altern Ther Health Med 13(4): 62-5. PMID: 17658124

Morris, R. C., Jr., Schmidlin, O., et al. (1999). Differing effects of supplemental KCl and KHCO3: pathophysiological and clinical implications. Semin Nephrol 19(5): 487-93. PMID: 10511388

Morselli, B., Neuenschwander, B., et al. (2000). [Osteoporosis diet]. Ther Umsch 57(3): 152-60. PMID: 10756695

Muhlbauer, R.C., Li, F. (1999). Effect of vegetables on bone metabolism. Nature 401(6751): 343-4. PMID: 10517630

Muhlbauer, R.C., Lozano, A., et al. (2002). Onion and a mixture of vegetables, salads, and herbs affect bone resorption in the rat by a mechanism independent of their base excess. J Bone Miner Res 17(7): 1230-6. PMID: 12096836

New, S.A., H.M. MacDonald, M.K. Campbell, et al. (2004). Lower estimates of net endogenous non-carbonic acid production are positively associated with indexes of bone health in premenopausal and perimenopausal women. Am J Clin Nutr 79: 131-138.

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New, S. (2004). Do vegetarians have a normal bone mass? Osteoporos Int 15(9): 679-88. PMID 15258721

New, S., Millward, D. (2003). Calcium, protein and fruit and vegetables as dietary determinants of bone health. Am J Clin Nutr 77(5): Letter to the Editor. http://www.ajcn.org/cgi/content/full/77/5/1340

New, S. A., J. P. Banjour. (2003) Acid-base homeostasis and the skeleton: Is there a fruit and vegetable link to bone health? In Nutritional aspects of bone health, ed. S. A. Lanham-New, J. P. Banjour. London: RSC Publishing, pp. 291-312.

New, S.A. (1999). Bone health: the role of micronutrients. Br Med Bull 55(3): 619-33. PMID: 10746351

New, S.A. (2001). Exercise, bone and nutrition. Proc Nutr Soc 60(2): 265-74. PMID: 11681642

New, S.A. (2002). Nutrition Society Medal lecture. The role of the skeleton in acid-base homeostasis. Proc Nutr Soc 61(2): 151-64. PMID: 12133196

New, S.A. (2003). Intake of fruit and vegetables: implications for bone health. Proc Nutr Soc 62(4): 889-99. PMID: 15018489

New, S.A., Bolton-Smith, C., et al. (1997). Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. Am J Clin Nutr 65(6): 1831-9. PMID: 9174480

New, S.A., Robins, S.P., et al. (2000). Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health? Am J Clin Nutr 71(1): 142-51. PMID: 10617959

Prynne, C.J., Ginty, F., et al. (2004). Dietary acid-base balance and intake of bone-related nutrients in Cambridge teenagers. Eur J Clin Nutr 58(11): 1462-71. PMID: 15162137

Rahbar, A., B. Larijani, et al. (2009). Relationship among dietary estimates of net endogenous acid production, bone mineral density and biochemical markers of bone turnover in an Iranian general population. Bone 45(5):876-81.

Reddy, S.T., Wang, C. Y., et al. (2002). Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism. Am J Kidney Dis 40(2): 265-74. PMID: 12148098

Remer, T. (2001). Influence of nutrition on acid-base balance—metabolic aspects. Eur J Nutr 40(5): 214-20. http://www.saeure-basen-forum.de/pdf/symp2001/remer.pdf

Remer, T., F. Manz (1994). Estimation of the renal net acid excretion by adults consuming diets containing variable amounts of protein. Am J Clin Nutr 59(6): 1356-61. PMID: 8198060

Remer, T., F. Manz (1995). Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc 95(7): 791-7.

Riond, J. L. (2001). Animal nutrition and acid-base balance. Eur J Nutr 40(5): 245-54. http://www.saeure-basen-forum.de/pdf/symp2001/riond.pdf

Sakhaee, K., N. M. Maalouf, et al. (2005). Effects of potassium alkali and calcium supplementation on bone turnover in postmenopausal women. J Clin Endocrinol Metab 90(6): 3528-33. PMID: 15755853

Sebastian, A., Frassetto, L.A., et al. (2002). Estimation of the net acid load of the diet of ancestral preagricultural Homo sapiens and their hominid ancestors. Am J Clin Nutr 76(6): 1308-16. PMID: 12450898

Sebastian, A., Harris, S.T., et al. (1994). Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. N Engl J Med 330(25): 1776-81. PMID: 8190153

Sellmeyer, D.E., M. Schloetter, et al. (2002). Potassium citrate prevents increased urine calcium excretion and bone resorption induced by a high sodium chloride diet. J Clin Endocrinol Metab 87(5): 2008-12. PMID: 11994333

Sellmeyer, D.E., K. L. Stone, et al. (2001). 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. Am J Clin Nutr 73(1): 118-22. PMID: 11124760

Sprague, S.M., Krieger, N.S., et al. (1993). Aluminum inhibits bone nodule formation and calcification in vitro. Am J Physiol 264(5 Pt 2): F882-90. PMID: 8498542

Sprague, S.M., Krieger, N.S., et al. (1994). Greater inhibition of in vitro bone mineralization with metabolic than respiratory acidosis. Kidney Int 46(4): 1199-206. PMID: 7861717

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Original Publication Date: 02/03/2003
Last Modified: 10/14/2011
Principal Author: Dr. Susan E. Brown, PhD