Osteologie 2008; 17(02): 51-54
DOI: 10.1055/s-0037-1619849
Ernährung und Knochengesundheit
Schattauer GmbH

Dietary protein intakes, bone growth and bone loss

Proteineinnahme mit der Nahrung, Knochenwachstum und Knochenverlust
R. Rizzoli
1   Division of Bone Diseases, WHO Collaborating Center for Osteoporosis Prevention, Department of Rehabilitation and Geriatrics, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
› Author Affiliations
Further Information

Publication History

Publication Date:
28 December 2017 (online)


There is a large body of evidences linking nutritional intakes, particularly protein, to bone growth, and to bone loss later in life, both influencing fracture risk. Sufficient dietary proteins are necessary for bone homeostasis during growth as well as in elderly. Several mechanisms, among them the growth hormone-IGF-I-target organ axis is likely to be implicated.


Viele wissenschaftliche Berichte sprechen dafür, dass die Ernährung, im Speziellen mit Proteinen, mit dem Knochenwachstum und mit dem Knochenverlust später im Leben verbunden ist, die beide das Frakturrisiko beeinflussen. Eine ausreichende Proteinzufuhr ist notwendig für die Knochenhomöostase, während des Wachstums wie auch im höheren Alter. Dabei spielen mehrere Mechanismen eine Rolle, darunter auch derjenige Prozess, der auf die Achse Wachstumshormon IGF-1-Organe einwirkt.

  • References

  • 1 Rizzoli R, Bonjour JP. Determinants of peak bone mass and mechanisms of bone loss. Osteoporos Int 1999; 09: S17-S23.
  • 2 Bonjour JP, Rizzoli R. In: Marcus R, Feldman D, Kelsey J. Bone acquisition in adolescence, vol. 1. San Diego: Academic Press; 2001: 621-638.
  • 3 Seeman E. The structural and biomechanical basis of the gain and loss of bone strength in women and men. Endocrinol Metab Clin NorthAm 2003; 32: 25-38.
  • 4 Theintz G, Buchs B, Rizzoli R. et al. Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. J Clin Endocrinol Metab 1992; 75: 1060-1065.
  • 5 Bonjour JP, Ammann P, Chevalley T, Rizzoli R. Protein intake and bone growth. Can J Appl Physiol 2001; 26 (Suppl): S153-S166.
  • 6 Chevalley T, Ferrari S, Hans D. et al. Protein intake modulates the effet of calcium supplementation on bone mass gain in prepubertal boys. J Bone Miner Res 2002; 17 (Suppl. 01) S172.
  • 7 Chevalley T, Bonjour JP, Ferrari S, Hans D, Rizzoli R. 2005 Skeletal site selectivity in the effects of calcium supplementation on areal bone mineral density gain: a randomized, double-blind, placebo-controlled trial in prepubertal boys. J Clin Endocrinol Metab 2005; 90: 3342-3349.
  • 8 Chevalley T, Bonjour JP, Ferrari S, Rizzoli R. High-Protein Intake Enhances the Positive Impact of Physical Activity on BMC in Prepubertal Boys. J Bone Miner Res 2008; 23: 131-142.
  • 9 Goulding A, Rockell JE, Black RE. et al. 2004 Children who avoid drinking cow’s milk are at increased risk for prepubertal bone fractures. J Am Diet Assoc 2004; 104: 250-253.
  • 10 Teegarden D, Lyle RM, Proulx WR, Johnston CC, Weaver CM. Previous milk consumption is associated with greater bone density in young women. Am J Clin Nutr 1999; 69: 1014-1017.
  • 11 Bounds W, Skinner J, Carruth BR, Ziegler P. The relationship of dietary and lifestyle factors to bone mineral indexes in children. J Am Diet Assoc 2005; 105: 735-741.
  • 12 Rockell JE, Williams SM, Taylor RW. et al. Twoyear changes in bone and body composition in young children with a history of prolonged milk avoidance. Osteoporos Int 2005; 16: 1016-1023.
  • 13 Opotowsky AR, Bilezikian JP. Racial differences in the effect of early milk consumption on peak and postmenopausal bone mineral density.J Bone Miner Res. 2003; 18: 1978-1988.
  • 14 Matkovic V, Landoll JD, Badenhop-Stevens NE. et al. Nutrition influences skeletal development from childhood to adulthood: a study of hip, spine, and forearm in adolescent females. J Nutr 2004; 134: S701-S705.
  • 15 Cheng S, Lyytikainen A, Kroger H. et al. Effects of calcium, dairy product, and vitamin D supplementation on bone mass accrual and body composition in 10–12-y-old girls: a 2-y randomized trial. Am J Clin Nutr. 2005 82. 1115–1126; quiz 1147–1148.
  • 16 Cadogan J, Eastell R, Jones N, Barker ME. Milk intake and bone mineral acquisition in adolescent girls: randomised, controlled intervention trial. Bmj 1997; 315: 1255-1260.
  • 17 Du X, Zhu K, Trube A. et al. Effects of school-milk intervention on growth and bone mineral accretion in Chinese girls aged 10–12 years: accounting for cluster randomisation. Br J Nutr 2005; 94: 1038-1039.
  • 18 Volek JS, Gomez AL, Scheett TP. et al. Increasing fluid milk favorably affects bone mineral density responses to resistance training in adolescent boys. J Am Diet Assoc 2003; 103: 1353-1356.
  • 19 Zhang Q, Ma GS, Greenfield H. et al. Effects of fortified milk consumption on regional bone mineral accrual in Chinese girls. Asia Pac J Clin Nutr 2003; 12 (Suppl.): S46.
  • 20 Zhu K, Du X, Cowell CT. et al. Effects of school milk intervention on cortical bone accretion and indicators relevant to bone metabolism in Chinese girls aged 10–12 y in Beijing. Am J Clin Nutr 2005; 81: 1168-1175.
  • 21 Zhu K, Greenfield H, Du X. et al. Effects of milk supplementation on cortical bone gain in Chinese girls aged 10–12 years. Asia Pac J Clin Nutr 2003; 12 (Suppl.): S47.
  • 22 Zhu K, Zhang Q, Foo LH. et al. Growth, bone mass, and vitamin D status of Chinese adolescent girls 3 y after withdrawal of milk supplementation. Am J Clin Nutr 2006; 83: 714-721.
  • 23 Devine A, Dick IM, Islam AF. et al. Protein consumption is an important predictor of lower limb bone mass in elderly women. Am J Clin Nutr 2005; 81: 1423-1428.
  • 24 Ho SC, Woo J, Lam S. et al. Soy protein consumption and bone mass in early postmenopausal Chinese women. Osteoporos Int 2003; 14: 835-842.
  • 25 Ilich JZ, Brownbill RA, Tamborini L. Bone and nutrition in elderly women: protein, energy, and calcium as main determinants of bone mineral density. Eur J Clin Nutr 2003; 57: 554-565.
  • 26 Kerstetter JE, Looker AC, Insogna KL. Low dietary protein and low bone density. Calcif Tissue Int 2000; 66: 313.
  • 27 Lau EM, Kwok T, Woo J, Ho SC. Bone mineral density in Chinese elderly female vegetarians, vegans, lacto-vegetarians and omnivores. Eur J Clin Nutr 1998; 52: 60-64.
  • 28 Michaelsson K, Holmberg L, Mallmin H. et al. Diet, bone mass, and osteocalcin: a cross-sectional study. Calcif Tissue Int 1995; 57: 86-93.
  • 29 Sellmeyer DE, Stone KL, Sebastian A, Cummings SR. 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 2001; 73: 118-122.
  • 30 Teegarden D, Lyle RM, McCabe GP. et al. Dietary calcium, protein, and phosphorus are related to bone mineral density and content in young women. Am J Clin Nutr 1998; 68: 749-754.
  • 31 Thorpe M, Mojtahedi MC, Chapman-Novakofski K. et al. A positive association of lumbar spine bone mineral density with dietary protein is suppressed by a negative association with protein sulfur.J Nutr. 2008; 138: 80-85.
  • 32 Tylavsky FA, Anderson JJ. Dietary factors in bone health of elderly lactoovovegetarian and omnivorous women. Am J Clin Nutr 1988; 48: 842-849.
  • 33 Coin A, Perissinotto E, Enzi G. et al. Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia. Eur J Clin Nutr. 2007 [Epub ahead of print].
  • 34 Orwoll ES, Weigel RM, Oviatt SK. et al. Serum protein concentrations and bone mineral content in aging normal men. Am J Clin Nutr 1987; 46: 614-621.
  • 35 Whiting SJ, Boyle JL, Thompson A. et al. Dietary protein, phosphorus and potassium are beneficial to bone mineral density in adult men consuming adequate dietary calcium. J Am Coll Nutr 2002; 21: 402-409.
  • 36 Hannan MT, Tucker KL, Dawson-Hughes B. et al. Effect of dietary protein on bone loss in elderly men and women: the Framingham Osteoporosis Study.J Bone Miner Res. 2000; 15: 2504-2512.
  • 37 Dawson-Hughes B, Harris SS. Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Am J Clin Nutr 2002; 75: 773-779.
  • 38 Dawson-Hughes B. Interaction of dietary calcium and protein in bone health in humans. J Nutr 2003; 133: S852S-S854.
  • 39 Anderson JJ, Metz JA. Adverse association of high protein intake to bone density. Challenges of Modern Medicine 1995; 07: 407-412.
  • 40 Metz JA, Anderson JJ, Gallagher Jr PN. Intakes of calcium, phosphorus, and protein, and physical-activity level are related to radial bone mass in young adult women. Am J Clin Nutr 1993; 58: 537-542.
  • 41 Abelow BJ, Holford TR, Insogna KL. 1992 Crosscultural association between dietary animal protein and hip fracture: a hypothesis. Calcif Tissue Int 1992; 50: 14-18.
  • 42 Frassetto LA, Todd KM, Morris Jr RC, Sebastian A. Worldwide incidence of hip fracture in elderly women: relation to consumption of animal and vegetable foods. J Gerontol A Biol Sci Med Sci 2000; 55: M585-M592.
  • 43 Feskanich D, Willett WC, Stampfer MJ, Colditz GA. Protein consumption and bone fractures in women. Am J Epidemiol 1996; 143: 472-479.
  • 44 Munger RG, Cerhan JR, Chiu BC. Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women. Am J Clin Nutr 1999; 69: 147-152.
  • 45 Meyer HE, Pedersen JI, Loken EB, Tverdal A. Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Am J Epidemiol 1997; 145: 117-123.
  • 46 Lemann Jr J. Relationship between urinary calcium and net acid excretion as determined by dietary protein and potassium: a review. Nephron 1999; 81 (Suppl. 01) 18-25.
  • 47 Heaney RP, Recker RR. Effects of nitrogen, phosphorus, and caffeine on calcium balance in women. J Lab Clin Med 1982; 99: 46-55.
  • 48 Kerstetter JE, O’Brien KO, Insogna KL. Dietary protein affects intestinal calcium absorption. Am J Clin Nutr 1998; 68: 859-865.
  • 49 Kerstetter JE, O’Brien KO, Insogna KL. Dietary protein, calcium metabolism, and skeletal homeostasis revisited. Am J Clin Nutr 2003; 78: S584-S592.
  • 50 Kerstetter JE, Mitnick ME, Gundberg CM. et al. Changes in bone turnover in young women consuming different levels of dietary protein. J Clin Endocrinol Metab 1999; 84: 1052-1055.
  • 51 Roughead ZK, Johnson LK, Lykken GI, Hunt JR. Controlled high meat diets do not affect calcium retention or indices of bone status in healthy postmenopausal women. J Nutr 2003; 133: 1020-1026.
  • 52 Heaney RP. Protein intake and bone health: the influence of belief systems on the conduct of nutritional science. Am J Clin Nutr 2001; 73: 5-6.
  • 53 Lutz J. Calcium balance and acid-base status of women as affected by increased protein intake and by sodium bicarbonate ingestion. Am J Clin Nutr 1984; 39: 281-288.
  • 54 Sebastian A, Harris ST, Ottaway JH. et al. Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. N Engl J Med 1994; 330: 1776-1781.
  • 55 Muhlbauer RC, Li F. Effect of vegetables on bone metabolism. Nature 1999; 401: 343-344.
  • 56 Muhlbauer RC, Lozano A, Reinli A. 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 2002; 17: 1230-1236.
  • 57 Lemann Jr J, Gray RW, Pleuss JA. Potassium bicarbonate, but not sodium bicarbonate, reduces urinary calcium excretion and improves calcium balance in healthy men. Kidney Int 1989; 35: 688-695.
  • 58 Sakhaee K, Nicar M, Hill K, Pak CY. Contrasting effects of potassium citrate and sodium citrate therapies on urinary chemistries and crystallization of stone-forming salts. Kidney Int 1983; 24: 348-352.
  • 59 Delmi M, Rapin CH, Bengoa JM. et al. Dietary supplementation in elderly patients with fractured neck of the femur. Lancet 1990; 335: 1013-1016.
  • 60 Tkatch L, Rapin CH, Rizzoli R. et al. Benefits of oral protein supplementation in elderly patients with fracture of the proximal femur. J Am Coll Nutr 1992; 11: 519-525.
  • 61 Schurch MA, Rizzoli R, Slosman D. et al. Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1998; 128: 801-809.
  • 62 Hampson G, Martin FC, Moffat K. et al. Effects of dietary improvement on bone metabolism in elderly underweight women with osteoporosis: a randomised controlled trial. Osteoporos Int 2003; 14: 750-756.
  • 63 Rodondi A, Ammann P, Rizzoli R. Effect of zinc supplements on the response to essential amino acid-whey protein supplements in frail elderly. Journal of the American Geriatric Society. 2008 (in press).
  • 64 Morin P, Herrmann F, Ammann P, Uebelhart B, Rizzoli R. A rapid self-administered food frequency questionnaire for the evaluation of dietary protein intake. Clin Nutr 2005; 24: 768-774.