Salt Effects on Bone and Calcium Metabolism

  • Richard L. Prince
  • Amanda Devine
Part of the Proceedings in the Serono Symposia USA Series book series (SERONOSYMP)


Salt has played a major role in the development of civilizations, and today it is a major and often hidden nutrient in the diets of many ethnic groups. Does it matter? In relation to bone and calcium metabolism the answer is probably yes, but more work is required before we can be definitive about it. Recent data from our unit raises the possibility that excessive salt directly reduces bone mass in postmenopausal women (1). In the following review we first consider possible mechanisms of action of salt on the kidney and bone. We then review what is known of the physiological effects of salt on calcium homeostasis and review the data on bone density. Finally we attempt an epidemiological perspective in terms of the importance of restricting salt intake as a public health measure to reduce osteoporotic fracture.


Sodium Intake Salt Intake Calcium Metabolism Calcium Excretion Dietary Calcium Intake 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Devine A, Criddle RA, Dick IM, Kerr DA, Prince RL. A longitudinal study of the effect of sodium and calcium intakes on regional bone density in postmenopausal women. Am J Clin Nutr 1995; 62: 740–5.PubMedGoogle Scholar
  2. 2.
    Walser M. Calcium clearance as a function of sodium clearance in the dog. Am J Physiol 1961; 200: 1099–104.PubMedGoogle Scholar
  3. 3.
    Massey LK, Whiting SJ. Dietary salt, urinary calcium, and bone loss. J Bone Miner Res 1996; 11: 731–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Brunette MG, Mailloux J, Lajeunesse D. Calcium transport through the luminal membrane of the distal tubule. I. Interrelationship with sodium. Kidney Int 1992; 41: 281–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Constanzo LS, Windhager EE. Effect of PTH, ADH and cyclic AMP on distal tubular Ca and Na reabsorption. Am J Physiol 1980; 239: 478–85.Google Scholar
  6. 6.
    Duarte CG, Watson JF. Calcium reabsorption in proximal tubule of the dog nephron. Am J Physiol 1967; 212: 1355–60.PubMedGoogle Scholar
  7. 7.
    Massry SG, Coburn JW, Chapman. LW, Kleeman CR. Effect of NaCI infusion on urinary Ca++ and Mg++ during reduction in their filtered loads. Am J Physiol 1967; 213: 1218–24.PubMedGoogle Scholar
  8. 8.
    Kurtz TW, Al-Bander HA, Morris RC. “Salt-sensitive” essential hypertension in men. N Engl J Med 1987; 317: 1043–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Sakhaee K, Nicar M, Hill K, Pak YC. Contrasting effects of potassium citrate and sodium citrate therapies on urinary chemistries and crystallization of stone-forming salts. Kidney Int 1983; 24: 348–52.PubMedCrossRefGoogle Scholar
  10. 10.
    Lemann 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: 688–95.PubMedCrossRefGoogle Scholar
  11. 11.
    Goulding A, McIntosh J, Campbell D. Effects of sodium bicarbonate and 1,25-dihydroxy-cholecalciferol on calcium and phosphorus balances in the rat. J Nutr 1984; 114: 653–9.PubMedGoogle Scholar
  12. 12.
    Sutton RAL, Wong NLM, Dirks JH. Effects of metabolic acidosis and alkalosis on sodium and calcium transport in the dog kidney. Kidney Int 1979; 15: 520–33.PubMedCrossRefGoogle Scholar
  13. 13.
    Greger LJ, Kaup SM, Behling AR. Calcium, magnesium and phosphorus utilization by rats fed sodium and potassium salts of various inorganic anions. J Nutr 1991; 121: 1382–8.PubMedGoogle Scholar
  14. 14.
    Bomsztyk K, Calalb MB. Bicarbonate absorption stimulates active calcium absorption in the rat proximal tubule. J Clin Invest 1988; 81: 1455–61.PubMedCrossRefGoogle Scholar
  15. 15.
    Brunette MG, Mailloux J, Lajeunesse D. Calcium transport by the lumina’ membrane of distal tubule: II. Effect of pH, electrical potential and calcium channel inhibitors. Kidney Int 1992; 41: 289–96.PubMedCrossRefGoogle Scholar
  16. 16.
    Sebastian A, Harris ST, Ottaway JH, Todd KM, Curtis Morris R, Jr. Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. N Engl J Med 1994; 330: 1776–81.PubMedCrossRefGoogle Scholar
  17. 17.
    Goulding A, Gold E. Effects of dietary NaCI supplementation on bone synthesis of hydroxyproline, urinary hydroxyproline excretion and bone 45Ca uptake in the rat. Honn Metab Res 1988; 20: 743–5.CrossRefGoogle Scholar
  18. 18.
    Chan ELP, Swaminathan R. Effect of different amounts of sodium intake for 4 months on calcium metabolism in normal and oophorectomized rats. J Bone Miner Res 1993; 8: 1185–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Goulding A. Fasting urinary sodium/creatinine in relation to calcium/creatinine and hydroxyproline/creatinine in a general population of women. N Z Med J 1981; 93: 294–7.PubMedGoogle Scholar
  20. 20.
    Itoh R, Suyama Y. Sodium excretion in relation to calcium and hydroxyproline excretion in a healthy Japanese population. Am J Clin Nutr 1996; 63: 735–40.PubMedGoogle Scholar
  21. 21.
    Need AG, Morris HA, Cleghorn DB, De Nichilo D, Horowitz M, Nordin BEC. Effect of salt restriction on urine hydroxyproline excretion in postmenopausal women. Arch Intern Med 1991; 151: 757–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Goulding A, Lim PE. Effects of varying dietary salt intake on the fasting urinary excretion of sodium, calcium and hydroxyproline in young women. N Z Med J 1983; 96: 853–4.Google Scholar
  23. 23.
    Breslau NA, McGuire JL, Zerwekh JE, Pak CYC. The role of dietary sodium on renal excretion and intestinal absorption of calcium and on vitamin D metabolism. J Clin Endocrinol Metab 1982; 55: 369–73.PubMedCrossRefGoogle Scholar
  24. 24.
    McParland BE, Goulding A, Campbell AJ. Dietary salt affects biochemical markers of resorption and formation of bone in elderly women. BMJ 1989; 299: 834–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Breslau NA, Sakhaee K, Pak CYC. Impaired adaptation to salt-induced urinary calcium losses in postmenopausal osteoporosis. Trans Assoc Am Physicians 1985; 98: 107–15.PubMedGoogle Scholar
  26. 26.
    Prince RL, Dick I, Devine A, Price RI, Gutteridge DH, Kerr D, et al. The effects of menopause and age on calcitropic hormones: a cross-sectional study of 655 healthy Women aged 35 to 90. J Bone Miner Res 1995; 10: 835–42.PubMedCrossRefGoogle Scholar
  27. 27.
    Gold E, Goulding A. High dietary salt intakes lower bone mineral density in ovariectomised rats: a dual x-ray absorptiometry study. Bone 1995;16 Suppl I:l 15S (abstract).Google Scholar
  28. 28.
    National Health and Medical Research Council. Recommended dietary intakes for use in Australia. Canberra: Australian Government Publishing Service, 1991.Google Scholar
  29. 29.
    Matkovic V, Illich JZ, Andon MB, Hsieh LC, Tzagournis MA, Lagger BJ, et al. Urinary calcium, sodium, and bone mass of young females. Am J Clin Nutr 1995; 62: 417–25.PubMedGoogle Scholar
  30. 30.
    Dawson-Hughes B, Fowler SE, Dalsky G, Gallagher C. Sodium excretion influences calcium homeostasis in elderly men and women. J Nutr 1996; 126: 2107–12.PubMedGoogle Scholar
  31. 31.
    Greendale GA, Barrett-Connor E, Edelstein S, Ingles S, Haile R. Dietary sodium and bone mineral density: results of a 16-year follow-up study. J Am Geriatr Soc 1994; 42: 1050–5.PubMedGoogle Scholar
  32. 32.
    National Health and Medical Research Council. Report of the working party on sodium in the Australian diet. Canberra: Australian Government Publishing Service, 1984.Google Scholar
  33. 33.
    Antonios TFT, MacGregor GA. Salt—more adverse effects. Lancet 1996; 348: 250–1.PubMedCrossRefGoogle Scholar
  34. 34.
    Devine A, Prince RL, Bell RR. Nutrient intake of postmenopausal women in relation to skeletal and cardiovascular disease. Aust J Nutr Diet 1996; 53: 144–50.Google Scholar
  35. 35.
    Department of Community Services and Health. National dietary survey: 1983, no. 2 nutrient intakes, 1st edition. Canberra: Australian Government Publishing Service, 1987.Google Scholar
  36. 36.
    Rowe PM. New US recommendations on calcium intake. Lancet 1994; 343: 155–960.CrossRefGoogle Scholar
  37. 37.
    Breslau NA, Brinkley L, Hill KD, Pak CYC. Relationship of animal protein-rich diet to kidney stone formation and calcium metabolism. J Clin Endocrinol Metab 1988; 66: 140–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Hegsted MS, Schuette SA, Zemel MB, Linkswiler HM. Urinary calcium and calcium balance in young men as affected by level of protein and phosphorus intake. J Nutr 1981; 111: 553–62.PubMedGoogle Scholar
  39. 39.
    Sabto J, Powell MJ, Breidahl MJ, Gurr FW. Influence of urinary sodium on calcium excretion in normal individuals. Med J Aust 1984; 140: 354–6.PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 1998

Authors and Affiliations

  • Richard L. Prince
  • Amanda Devine

There are no affiliations available

Personalised recommendations