The Effect of Sodium on Calcium Requirement

  • B. E. Christopher Nordin
  • Allan G. Need
Part of the Advances in Nutritional Research book series (ANUR, volume 9)


Ever since Walser (1961) demonstrated the powerful effect of sodium infusion on calcium excretion in dogs, there has been a continuing interest in the relationship between sodium and calcium excretion in human subjects and in various animal species. It has become increasingly clear that sodium intake is an important determinant of obligatory calcium loss, and this in turn has aroused interest in the role of sodium in the pathogenesis of osteoporosis and the role of salt restriction in its management. At the same time, renal physiologists have sought to describe and explain (with only partial success) the nature of the mechanisms which link sodium and calcium transport in the kidneys. The present position is that more is known about the empirical effects of sodium intake on urine calcium than on the nature of the mechanism which governs this relationship. This review is therefore necessarily more concerned with outcomes than with mechanisms, but the latter will be reviewed in brief.


Postmenopausal Woman Premenopausal Woman Calcium Intake Sodium Intake Sodium Excretion 
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. Agus, Z.S., and Goldfarb, S., 1985, “Renal regulation of calcium balance,” in: The Kidney: Physiology and Pathophysiology ( D.W. Seldin and G. Giebisch, eds.), pp. 1323–1335, Raven Press, New York.Google Scholar
  2. Berry, C.A., and Rector, F.C., 1991, “Renal transport of glucose, amino acids, sodium, chloride, and water,” in: The Kidney ( B.M. Brenner and F.C. Rector, eds.), pp. 245–282, W.B. Saunders, Philadelphia.Google Scholar
  3. Bourdeau, J.E., and Burg, M.B., 1980, Effect of PTH on calcium transport across the cortical thick ascending limb of Henle’s loop, Am. J. Physiol. 239: F121.Google Scholar
  4. Breslau, N.A., McGuire J.L., Zerwekh, J.E., and Pak, C.Y.C., 1982, The role of dietary sodium on renal excretion and intestinal absorption of calcium and on vitamin D metabolism, J Clin. Endocrinol. Metab. 55: 369.CrossRefGoogle Scholar
  5. Breslau, N.A., Sakhaee, K., and Pak, C.Y.C., 1985, Impaired adaptation to salt-induced urinary calcium losses in postmenopausal osteoporosis, Trans. Assoc. Am. Physician 98: 107.Google Scholar
  6. Brunette, M.G., Mailloux, J., and Lajeunesse, D., 1992, Calcium transport through the luminal membrane of the distal tubule: 1. Interrelationship with sodium, Kidney Int. 41: 281.CrossRefGoogle Scholar
  7. Charles, P., Taagehoj, F., Jensen, L., Mosekilde, L., and Hansen, H.H., 1983, Calcium metabolism evaluated by Ca45 kinetics: estimation of dermal calcium loss, Clinical Science, 65: 415.Google Scholar
  8. Christiansen, C., Christensen, M., Larsen, N-E., and Transbol, LB., 1982, Pathophysiological mechanisms of estrogen effect on bone metabolism. Dose-response relationships in early postmenopausal women, J. Clin. Endocrinol. Metab. 55: 1124.CrossRefGoogle Scholar
  9. Costanzo, L.S., 1984, Comparison of calcium and sodium transport in early and late rat distal tubules: effect of amiloride, Am. J. Physiol. 246: F937.Google Scholar
  10. Costanzo, L.S., and Weiner, I.M., 1976, Relationship between clearances of Ca and Na: effect of distal diuretics and PTH, Am. J Physiol. 30: 67.Google Scholar
  11. Costanzo, L.S., and Windhager, E.E., 1980, Effects of PTH, ADH, and cyclic AMP on distal tubular Ca and Na reabsorption, Am. J. Physiol. 239: F478.Google Scholar
  12. Edwards, B.R., Baer, P.G., Sutton, R.A.L., and J.H. Dirks, 1973, Micropuncture study of diuretic effects on sodium and calcium reabsorption in the dog nephron, J. Clin. Invest. 52: 2418.CrossRefGoogle Scholar
  13. Epstein, F.H., 1968, Calcium and the kidney, Am. J. Med. 45: 700.CrossRefGoogle Scholar
  14. Epstein, M., and Hollenberg, N.K. 1976, Age as a determinant of renal sodium conservation in normal man, J Lab. Clin Med. 87: 411.Google Scholar
  15. Gallagher, J.C., and Nordin, B.E.C., 1975, “Effects of oestrogen and progestogen therapy on calcium metabolism in postmenopausal women,” in: Estrogens in the Post-Menopause, Frontiers of Hormone Research, vol. 3 (P.A. vanKeep and C. Lauritzen, eds.), pp. 150176, Karger, Basel.Google Scholar
  16. Goulding, A., 1980, Effects of dietary NaCI supplements on parathyroid function, bone turnover and bone composition in rats taking restricted amounts of calcium, Mineral Electrolyte Metab. 4: 203.Google Scholar
  17. Goulding, A., 1981, Fasting urinary sodium/creatinine in relation to calcium/creatinine and hydroxyproline/creatinine in a general population of women, New Zealand. Med J. 93: 294.Google Scholar
  18. Goulding, A., and Campbell, D., 1983, Dietary NaCI loads promote calciuria and bone loss in adult oophorectomized rats consuming a low calcium diet, J. Nutr. 113: 1409.Google Scholar
  19. Goulding, A., and Campbell, D.R., 1984, Effects of oral loads of sodium chloride on bone composition in growing rats consuming ample dietary calcium, Mineral Electrolyte Metab. 10: 58.Google Scholar
  20. Goulding, A., and Lim, P.E., 1983, Effects of varying dietary salt intake on the fasting urinary excretion of sodium, calcium and hydroxyproline in young women, New Zealand Med. J. 96: 853.Google Scholar
  21. Goulding, A., McIntosh, J., and Campbell, D., 1984, Effects of sodium bicarbonate on calcium and phosphorus balances in the rat, J. Nutr. 114: 653.Google Scholar
  22. Goulding, A., Everitt, H.E., Cooney, J.M., and Spears, G.F.S., 1986, “Sodium and osteoporosis,” in: Recent Advances in Clinical Nutrition 2 ( M.L. Wahlqvist and A.S. Truswell, eds.), pp. 99–108, John Libbey, London.Google Scholar
  23. Hanson, R.C., White, J.B., and Gomoll, A.W., 1982, Acute and chronic diuretic-induced alterations in urinary sodium and calcium excretion in the conscious rat, Mineral Electrolyte Metab. 8: 314.Google Scholar
  24. Harden, R.McG., 1964, Calcium excretion in thermal sweat in thyrotoxicosis, J. Endocrinol. 28: 153.CrossRefGoogle Scholar
  25. Harinck, H.I.J., Bijvoet, O.L.M., Plantingh, A.S.T., Body, J-J., Elte, J.W.F., Sleeboom, H.P., Wildiers, J., and Neijt, J.P., 1987, Role of bone and kidney in tumor-induced hypercalcemia and its treatment with bisphosphonate and sodium chloride, Am. J. Med. 82: 1113.CrossRefGoogle Scholar
  26. Hasling, C., Charles, P., Jenson, F.T., and Mosekilde, L., 1990, Calcium metabolism in postmenopausal osteoporosis: the influence of dietary calcium and net absorbed calcium, J. Bone Min. Res. 5: 939.CrossRefGoogle Scholar
  27. Heaney, R.P., Recker, R.R., and Saville, P.D., 1978, Menopausal changes in calcium balance performance, J. Lab. Clin. Med. 92: 953.Google Scholar
  28. Kelly, P.J., Pocock, N.A., Sambrook, P.N., and Eisman, J.A., 1989, Age and menopauserelated changes in indices of bone turnover, J. Clin. Endocrinol. Metab. 69: 1160.CrossRefGoogle Scholar
  29. King, J.S., Jackson, R., and B. Ashe, 1964, Relation of sodium intake to urinary calcium excretion, Invest. Urology 1: 555.Google Scholar
  30. Kleeman, C.R., Bohannan, J., Bernstein, D., Ling, S., and Maxwell, M.H., 1964, Effect of variations in sodium intake on calcium excretion in normal humans, Proc. Soc. Exp. Biol.Med. 115: 29.Google Scholar
  31. Kurtz, T.W., Al-Bander, H.A., and Morris, R.C., 1987, `Salt-sensitive’ essential hypertension in men, N. Engl. J. Med. 317:1043.Google Scholar
  32. Massry, S.G., Coburn, J.W., Chapman, L.W., and Kleeman, C.R., 1967, Effect of NaCI infusion on urinary Ca++ and Mg++ during reduction of their filtered loads, Am. J. Physiol. 213: 1218Google Scholar
  33. McCarron, D.A., Rankin, L.I., Bennett, W.M., Krutzig, S., McClung, M.R., and Luft, F.C., 1981, Urinary calcium excretion at extremes of sodium intake in normal man, Am. J. Nephrol. 1: 84.CrossRefGoogle Scholar
  34. McLean F.C., and Urist, M.R., eds., 1968, Bone: Fundamentals of the Physiology of Skeletal Tissue, 3rd Edition, University of Chicago Press, Chicago.Google Scholar
  35. McParland, B.E., Goulding, A., and Campbell, A.J., 1989, Dietary salt affects biochemical markers of resorption and formation of bone in elderly women, Br. Med. J. 299: 834.CrossRefGoogle Scholar
  36. Morris, H.A., Need, A.G., Horowitz, M., O’Loughlin, P.D., and Nordin, B.E.C., 1991, Calcium absorption in normal and osteoporotic postmenopausal women, Calcif. Tissue Int. 49: 240.CrossRefGoogle Scholar
  37. Muldowney, F.P., Freaney, R, and Moloney, M.F., 1982, Importance of dietary sodium in the hypercalciuria syndrome, Kidney Int. 22: 292.CrossRefGoogle Scholar
  38. Need, A.G., Morris, H.A., Cleghorn, D.B., DeNichilo, D., Horowitz, M., and Nordin, B.E.C., 1991, Effect of salt restriction on urine hydroxyproline excretion in postmenopausal women, Arch. Intern. Med. 151: 757.CrossRefGoogle Scholar
  39. Nordin, B.E.C., 1960, Osteomalacia, osteoporosis and calcium deficiency. Clin. Orthopaedics 17: 235.Google Scholar
  40. Nordin, B.E.C., 1978, Diagnostic procedures in disorders of calcium metabolism. Clinical Endocrinol. 8: 55.CrossRefGoogle Scholar
  41. Nordin, B.E.C., and Marshall, D.H., 1988, “Dietary requirements for calcium,” in: Calcium in Human Biology ( B.E.C. Nordin, ed.), pp. 447–471, Springer, Berlin.CrossRefGoogle Scholar
  42. Nordin, B.E.C., and Polley, K.J., 1987, Metabolic consequences of the menopause: A cross-sectional, longitudinal, and intervention study on 557 normal postmenopausal women, Caleif. Tissue Int. 41: S1.CrossRefGoogle Scholar
  43. Nordin, B.E.C., Need, A.G., Hartley, T.F., Philcox, J.C., Wilcox, M., and Thomas, D.W., 1989, Improved method for calculating calcium fractions in plasma: reference values and effect of menopause, Clin. Chem. 35: 14.Google Scholar
  44. Nordin, B.E.C., Morris, H.A., Need, A.G., Horowitz, M., and Robertson, W.G., 1990, Relationship between plasma calcium fractions, other bone-related variables, and serum follicle-stimulating hormone levels in premenopausal, perimenopausal, and postmenopausal women, Am. J. Obstet. Gynecol. 163: 140.Google Scholar
  45. Nordin, B.E.C., Need, A.G., Morris, H.A., Horowitz, M., and Robertson, W.G., 1991, Evidence for a renal calcium leak in postmenopausal women,. 1 Clin. Endocrinol. Metab. 72: 401.CrossRefGoogle Scholar
  46. Parfitt, A.M., 1989, Plasma calcium control at quiescent bone surfaces: A new approach to the homeostatic function of bone lining cells, Bone 10: 87.CrossRefGoogle Scholar
  47. Phillips, M.J., and Cooke, J.N.C., 1967, Relation between urinary calcium and sodium in patients with idiopathic hypercalciuria, Lancet i:1354.Google Scholar
  48. Reid, I.R., Schooler, B.A., Hannan, S.F., and Ibbertson, H.K., 1986, The acute biochemical effects of four proprietary calcium preparations. Aust. NZ J. Med. 16: 193.CrossRefGoogle Scholar
  49. Sabto, J., Powell, M.J., Breidahl, M.J., and Gurr, F’.W., 1984, Influence of urinary sodium on calcium excretion in normal individuals. Med. J. Aust. 140: 354.Google Scholar
  50. Sakhaee, K., Nicar, M.J., Glass, K., and Pak, C.Y., 1985, Postmenopausal osteoporosis as a manifestation of renal hypercalciuria with secondary hyperparathyroidism, J. Clin. Endocrinol. Metab. 61 (2): 368.CrossRefGoogle Scholar
  51. Silver, J., Rubinger, D., Friedlaender, M.M., and Popovtzer, M.M., 1983, Sodium-dependent idiopathic hypercalciuria in renal-stone formers, Lancet :484.Google Scholar
  52. Simpson, F.O., Nye, E.R., Bolli, P., Waal-Manning, H.J., Goulding, A.W., Phelan, E.L., deHamel, F.A., Stewart,.D.H., Spears, G.F.S., Leek, G.M., and Stewart, A.C., 1978, The Milton Survey: Part 1, General methods, height, weight and 24-hour excretion of sodium, potassium, calcium, magnesium and creatinine, New Zealand Med. J. 87: 379.Google Scholar
  53. Staub, J.F., Tracqui, P., Lausson, S., Milhaud, G., and Perault-Staub, A.M., 1989, A physiological view of in vivo calcium dynamics: the regulation of a nonlinear self-organized system, Bone 10: 77.CrossRefGoogle Scholar
  54. Stepan, J.J., Pospichal, J., Presl, J., and Pacovsky, V., 1987, Bone loss and biochemical indices of bone remodeling in surgically induced postmenopausal women, Bone 8: 279.CrossRefGoogle Scholar
  55. Sutton, R.A.L., Wong, N.L.M., and Dirks, J.1-I., 1979, Effects of metabolic acidosis and alkalosis on sodium and calcium transport in the dog kidney, Kidney Int. 15: 520.CrossRefGoogle Scholar
  56. Walser, M., 1961, Calcium clearance as a function of sodium clearance in the dog, Am. J. Physiol. 200: 769.Google Scholar
  57. Wong, N.L.M., and Quamme, G.A., 1990, Association of calcium and sodium handling in the rabbit nephron, Renal Physiol. Biochem. 13: 306.Google Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • B. E. Christopher Nordin
    • 1
    • 2
  • Allan G. Need
    • 3
  1. 1.Division of Clinical BiochemistryInstitute of Medical and Veterinary ScienceAdelaideAustralia
  2. 2.Department of PathologyThe University of AdelaideAustralia
  3. 3.Division of Clinical BiochemistryInstitute of Medical and Veterinary ScienceAdelaideAustralia

Personalised recommendations