Urinary Citrate Excretion May Be Indirect Biomarker of Bone Health

MedicalResearch.com Interview with:
Jonas Esche

Dipl.-Mol. Biomed
University of Bonn
Institute of Nutritional and Food Sciences

MedicalResearch.com: What is the background for this study?

Response: Modern western diets increase diet-dependent acid load and net acid excretion which are suggested to have adverse long-term effects on bone. Urinary potential renal acid load (uPRAL) is an established parameter to assess nutritional acid load. Urinary citrate, on the other hand, integrates nutritional and also systemic influences on acid-base homeostasis with high citrate indicating prevailing alkalization.
Against this background urinary citrate excretion was used as a new index of acid-base status and its relationship with bone strength and long-term fracture risk was examined.

MedicalResearch.com: What are the main findings?

Response: In prospective analyses of 231 healthy children enrolled in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study, we found that urinary citrate excretion was positively associated with major parameters of bone quality and geometry, e.g., with strength strain index and periosteal circumference.

Moreover, it could be shown that fracture risk in adult females, but not in males, was inversely associated with urinary citrate and positively with uPRAL.

MedicalResearch.com: What should readers take away from your report?

Response: Our results on urinary citrate excretion as an integrated noninvasive biomarker of endogenous acid-base status substantiate dietary and metabolic acidity as potentially adverse for bone health in the long run from childhood onward. Already slight changes to a more acidic status – still in the physiological range – can have detrimental long-term effects on bone health. A more alkaline diet, rich in fruits and vegetables appears to strengthen bone.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: There is still need for further research identifying probably existing endocrine or metabolic confounders of urinary citrate excretion.

MedicalResearch.com: Is there anything else you would like to add?

Response: Slight shifts of acid-base status into a more acidic direction adversely affect bone status. To uncover these small long-term important effects, adjusting for strong confounders as for example muscle area, bone length or protein intake is of particular importance, and is often not appropriately done in other studies. 

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Urinary citrate, an index of acid-base status, predicts bone strength in
youth and fracture risk in adult females.

Jonas Esche 1 , Simone Johner1 , Lijie Shi1 , Eckhard Schönau2 , Thomas Remer1 1 DONALD Study Dortmund, Department of Nutritional Epidemiology, Institute of Nutritional and Food Sciences (IEL), University of Bonn, Dortmund, Germany; 2 Children’s Hospital, University of Cologne, Cologne, Germany
doi: 10.1210/jc.2016-2677
J Clin Endocrinol Metab

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Last Updated on October 3, 2016 by Marie Benz MD FAAD