Effect of high dietary sodium on bone turnover markers and urinary calcium excretion in Korean postmenopausal women with low bone mass

Eur J Clin Nutr. 2015 Mar;69(3):361-6. doi: 10.1038/ejcn.2014.284. Epub 2015 Feb 4.


Background/objectives: High salt intake is a well-recognized risk factor of osteoporosis for its modulating effect on calcium metabolism. To understand the effect of dietary sodium on bone turnover, we evaluated the association between urinary sodium excretion and bone turnover markers in Korean postmenopausal women with low bone mass.

Subjects/methods: A retrospective review of medical records at a single institution identified 537 postmenopausal women who were first diagnosed with osteopenia or osteoporosis between 2008 and 2013. Subjects were stratified by low (<2 g/day, n=77), moderate (2-4.4 g/day, n=354) and high (⩾4.4 g/day, n=106) sodium excretion. A 24-h urine was collected to estimate sodium, calcium and creatinine. Bone turnover markers and calciotropic hormones were measured in serum. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry.

Results: Sodium intake was positively associated with urinary sodium excretion (P=0.006, r=0.29). Bone turnover markers were significantly higher in the moderate-to-high urinary sodium excretion group (⩾2 g/day) than in the low urinary sodium excretion group (<2 g/day); CTX-I (C-telopeptides of type I collagen) was 21.3% higher (P=0.001) and osteocalcin (OC) was 15.7% higher (P=0.004). Calciotropic hormones and BMD were not significantly different across the sodium excretion groups.

Conclusions: High urinary sodium excretion (⩾2 g/day) increased bone turnover markers in Korean postmenopausal women, suggesting that excessive sodium intake might accelerate bone turnover.

MeSH terms

  • Aged
  • Biomarkers / blood
  • Bone Density / drug effects
  • Bone and Bones / drug effects*
  • Bone and Bones / metabolism
  • Calcium / urine*
  • Collagen Type I / blood
  • Diet*
  • Female
  • Humans
  • Lumbar Vertebrae / drug effects
  • Lumbar Vertebrae / metabolism
  • Middle Aged
  • Osteocalcin / blood
  • Osteoporosis, Postmenopausal / etiology
  • Osteoporosis, Postmenopausal / metabolism*
  • Peptides / blood
  • Postmenopause
  • Republic of Korea
  • Retrospective Studies
  • Sodium Chloride, Dietary / adverse effects
  • Sodium Chloride, Dietary / pharmacology
  • Sodium Chloride, Dietary / urine
  • Sodium, Dietary / adverse effects
  • Sodium, Dietary / pharmacology*
  • Sodium, Dietary / urine


  • Biomarkers
  • Collagen Type I
  • Peptides
  • Sodium Chloride, Dietary
  • Sodium, Dietary
  • collagen type I trimeric cross-linked peptide
  • Osteocalcin
  • Calcium