Nutr Res Pract.  2020 Feb;14(1):55-61. 10.4162/nrp.2020.14.1.55.

The association of potassium intake with bone mineral density and the prevalence of osteoporosis among older Korean adults

• Ha J
• Kim SA
• Lim K
• Shin S

• KMID: 2468513
• DOI: http://doi.org/10.4162/nrp.2020.14.1.55

Abstract

BACKGROUND/OBJECTIVES
Osteoporosis is characterized by low bone mass and results in vulnerability to fracture. Calcium and vitamin D are known to play an important role in bone health. Recently, potassium has been identified as another important factor in skeletal health. We examined the link between potassium intake and bone health among the Korean older adult population.
SUBJECTS/METHODS
This retrospective, cross-sectional study included 8,732 men and postmenopausal women over 50 years old who completed the Korean National Health and Nutrition Survey (KNHANES) between 2008 and 2011. Potassium consumption was evaluated using a 24-hour recall method. Bone mineral density (BMD) was measured at three sites (total hip, femur neck, and lumbar spine) by dual-energy X-ray absorptiometry (DEXA). Multinomial logistic regression was used to examine the link between potassium intake and prevalence of osteoporosis and osteopenia, after controlling for potential confounding variables.
RESULTS
The BMD of the total femur and Ward's triangle were significantly different according to the potassium intake among men (P = 0.031 and P = 0.010, respectively). Women in the top tertile for potassium intake showed higher BMD than those in the bottom tertile at all measurement sites (all P < 0.05). Daily potassium intake was significantly related to a decreased risk of osteoporosis at the lumbar spine in postmenopausal women (odds ratios: 0.68, 95% confidence interval: 0.48-0.96, P trend = 0.031). However, the dietary potassium level was not related to the risk of osteoporosis in men.
CONCLUSION
Current findings indicate that higher dietary potassium levels have a favorable effect on bone health and preventing osteoporosis in older Korean women.

Keyword

Osteoporosis; epidemiology; KNHANES; nutrition; population surveillance

MeSH Terms

Absorptiometry, Photon
Adult*
Bone Density*
Bone Diseases, Metabolic
Calcium
Confounding Factors (Epidemiology)
Cross-Sectional Studies
Epidemiology
Female
Femur
Femur Neck
Hip
Humans
Logistic Models
Male
Methods
Nutrition Surveys
Osteoporosis*
Population Surveillance
Potassium*
Potassium, Dietary
Prevalence*
Retrospective Studies
Spine
Vitamin D
Calcium
Potassium
Potassium, Dietary
Vitamin D

Reference

1. Glaser DL, Kaplan FS. Osteoporosis Definition and clinical presentation. Spine (Phila Pa 1976). 1997; 22:12S–16S.

2. Zhu K, Devine A, Prince RL. The effects of high potassium consumption on bone mineral density in a prospective cohort study of elderly postmenopausal women. Osteoporos Int. 2009; 20:335–340.

3. Rachner TD, Khosla S, Hofbauer LC. Osteoporosis: now and the future. Lancet. 2011; 377:1276–1287.

4. Park EJ, Joo IW, Jang MJ, Kim YT, Oh K, Oh HJ. Prevalence of osteoporosis in the Korean population based on Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2011. Yonsei Med J. 2014; 55:1049–1057.

5. Lim S. Eating a balanced diet: a healthy life through a balanced diet in the age of longevity. J Obes Metab Syndr. 2018; 27:39–45.

6. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R. National Osteoporosis Foundation. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014; 25:2359–2381.

7. Dawson-Hughes B, Dallal GE, Krall EA, Harris S, Sokoll LJ, Falconer G. Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Ann Intern Med. 1991; 115:505–512.

8. Heaney RP. Nutritional factors in osteoporosis. Annu Rev Nutr. 1993; 13:287–316.

9. New SA, Bolton-Smith C, Grubb DA, Reid DM. Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. Am J Clin Nutr. 1997; 65:1831–1839.

10. Kong SH, Kim JH, Hong AR, Lee JH, Kim SW, Shin CS. Dietary potassium intake is beneficial to bone health in a low calcium intake population: the Korean National Health and Nutrition Examination Survey (KNHANES) (2008-2011). Osteoporos Int. 2017; 28:1577–1585.

11. Barzel US. The skeleton as an ion exchange system: implications for the role of acid-base imbalance in the genesis of osteoporosis. J Bone Miner Res. 1995; 10:1431–1436.

12. Hamm LL, Nakhoul N, Hering-Smith KS. Acid-base homeostasis. Clin J Am Soc Nephrol. 2015; 10:2232–2242.

13. Wachman A, Bernstein DS. Diet and osteoporosis. Lancet. 1968; 1:958–959.

14. Barzel US, Massey LK. Excess dietary protein can adversely affect bone. J Nutr. 1998; 128:1051–1053.

15. Bushinsky DA, Riordon DR, Chan JS, Krieger NS. Decreased potassium stimulates bone resorption. Am J Physiol. 1997; 272:F774–F780.

16. Dawson-Hughes B, Harris SS, Palermo NJ, Castaneda-Sceppa C, Rasmussen HM, Dallal GE. Treatment with potassium bicarbonate lowers calcium excretion and bone resorption in older men and women. J Clin Endocrinol Metab. 2009; 94:96–102.

17. Sebastian A, Harris ST, Ottaway JH, Todd KM, Morris RC Jr. Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. N Engl J Med. 1994; 330:1776–1781.

18. Lemann J Jr, 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.

19. Sakhaee K, Nicar M, Hill K, Pak CY, Sakhaee K. Contrasting effects of potassium citrate and sodium citrate therapies on urinary chemistries and crystallization of stone-forming salts. Kidney Int. 1983; 24:348–352.

20. Weaver CM. Potassium and health. Adv Nutr. 2013; 4:368S–377S.

21. Lewiecki EM, Gordon CM, Baim S, Leonard MB, Bishop NJ, Bianchi ML, Kalkwarf HJ, Langman CB, Plotkin H, Rauch F, Zemel BS, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Silverman S. International Society for Clinical Densitometry 2007 adult and pediatric official positions. Bone. 2008; 43:1115–1121.

22. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, Chun C, Khang YH, Oh K. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol. 2014; 43:69–77.

23. Rural Development Administration (KO). Food Composition Table. Suwon: Rural Development Administration;2006.

24. Willet W. Nutritional Epidemiology. New York (NY): Oxford University Press;2012.

25. Orimo H, Hayashi Y, Fukunaga M, Sone T, Fujiwara S, Shiraki M, Kushida K, Miyamoto S, Soen S, Nishimura J, Oh-Hashi Y, Hosoi T, Gorai I, Tanaka H, Igai T, Kishimoto H. Osteoporosis Diagnostic Criteria Review Committee: Japanese Society for Bone and Mineral Research. Diagnostic criteria for primary osteoporosis: year 2000 revision. J Bone Miner Metab. 2001; 19:331–337.

26. Yeom HA, Jung D, Choi M. Adherence to physical activity among older adults using a Geographic Information System: Korean National Health and Nutrition Examinations Survey IV. Asian Nurs Res (Korean Soc Nurs Sci). 2011; 5:118–127.

27. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O'Brien WL, Bassett DR Jr, Schmitz KH, Emplaincourt PO, Jacobs DR Jr, Leon AS. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000; 32:S498–S504.

28. IPAQ Group. Guidelines for data processing and analysis of the International Physical Activity Questionnaire [Internet]. [place unknown]: IPAQ Group;2018. cited 2018 September 21. Available from: http://www.ipaq.ki.se.

29. Shin S, Joung H. A dairy and fruit dietary pattern is associated with a reduced likelihood of osteoporosis in Korean postmenopausal women. Br J Nutr. 2013; 110:1926–1933.

30. Hayhoe RP, Lentjes MA, Luben RN, Khaw KT, Welch AA. Dietary magnesium and potassium intakes and circulating magnesium are associated with heel bone ultrasound attenuation and osteoporotic fracture risk in the EPIC-Norfolk cohort study. Am J Clin Nutr. 2015; 102:376–384.

31. Dawson-Hughes B, Harris SS, Palermo NJ, Gilhooly CH, Shea MK, Fielding RA, Ceglia L. Potassium bicarbonate supplementation lowers bone turnover and calcium excretion in older men and women: a randomized dose-finding trial. J Bone Miner Res. 2015; 30:2103–2111.

32. Gregory NS, Kumar R, Stein EM, Alexander E, Christos P, Bockman RS, Rodman JS. Potassium citrate decreases bone resorption in postmenopausal women with osteopenia: a randomized, double-blind clinical trial. Endocr Pract. 2015; 21:1380–1386.

33. Whiting SJ, Boyle JL, Thompson A, Mirwald RL, Faulkner RA. 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.

34. Tucker KL, Hannan MT, Kiel DP. The acid-base hypothesis: diet and bone in the Framingham Osteoporosis Study. Eur J Nutr. 2001; 40:231–237.

35. Chan JC. Nutrition and acid-base metabolism. Fed Proc. 1981; 40:2423–2428.

36. Remer T, Manz F. Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc. 1995; 95:791–797.

37. Lemann J Jr, Pleuss JA, Gray RW. Potassium causes calcium retention in healthy adults. J Nutr. 1993; 123:1623–1626.

38. Sebastian A, Morris RC Jr. Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. N Engl J Med. 1994; 331:279.