Acid–Base Homeostasis and Skeletal Health: Current Thinking and Future Perspectives

Abstract

We urgently need public health strategies to help with the prevention of poor bone health across the age ranges. It is especially useful to focus attention on factors that are amenable to change, with nutrition and exercise having clear potential. The aim of this chapter is to review the current evidence for a role of acid–base homeostasis in bone. Analysis of existing literature enabled a combination of observational, clinical, and intervention studies to be assessed in relation to dietary alkalinity, dietary acidity and bone health. Mechanisms of action for a dietary alkalinity “component” effect were examined, and the role that fruit and vegetables can play in bone health was addressed. Natural, pathological, and experimental states of acid loading/acidosis have been associated with hypercalciuria, and negative calcium balance and, more recently, the detrimental effects of “acid” from the diet on bone mineral have been demonstrated. At the cellular level, a reduction in extracellular pH has been shown to enhance osteoclastic activity directly, resulting in increased resorption pit formation.

A number of observational, experimental, clinical, and intervention studies have suggested a positive link between fruit and vegetable consumption and the skeleton. Further research is required, particularly with respect to the influence of dietary manipulation using alkali-forming foods on fracture prevention. There remain no long-term Dietary Approaches to Stop Hypertension (DASH) on bone health in younger and older age cohorts, and this is urgently required. Should the findings of the DASH/fruit and vegetable studies prove conclusive, a “fruit and vegetable” approach to bone health maintenance may provide a very helpful strategy for bone health development and maintenance throughout the life cycle.