Association of Protein Intake with Bone Mineral Density and Bone Mineral Content among Elderly Women: The OSTPRE Fracture Prevention Study

J Nutr Health Aging. 2017;21(6):622-630. doi: 10.1007/s12603-016-0800-4.


It has been hypothesized that high protein intakes are associated with lower bone mineral content (BMC). Previous studies yield conflicting results and thus far no studies have undertaken the interaction of body mass index (BMI) and physical activity with protein intakes in relation to BMC and bone mineral density (BMD).

Objective: To evaluate the associations of dietary total protein (TP), animal protein (AP) and plant protein (PP) intakes with BMC and BMD and their changes. We tested also the interactions of protein intake with, obesity (BMI ≤30 vs. >30 kg/m2) and physical activity level (passive vs. active). Design/ Setting: Prospective cohort study (Osteoporosis Risk-Factor and Fracture-Prevention Study). Participants/measures: At the baseline, 554 women aged 65-72 years filled out a 3-day food record and a questionnaire covering data on lifestyle, physical activity, diseases, and medications. Intervention group received calcium 1000 mg/d and cholecalciferol 800 IU for 3 years. Control group received neither supplementation nor placebo. Bone density was measured at baseline and year 3, using dual energy x-ray absorptiometry. Multivariable regression analyses were conducted to examine the associations between protein intake and BMD and BMC.

Results: In cross-sectional analyses energy-adjusted TP (P≤0·029) and AP (P≤0·045) but not PP (g/d) were negatively associated with femoral neck (FN) BMD and BMC. Women with TP≥1·2 g/kg/body weight (BW) (Ptrend≤0·009) had lower FN, lumbar spine (LS) and total BMD and BMC. In follow-up analysis, TP (g/kg/BW) was inversely associated with LS BMD and LS BMC. The detrimental associations were stronger in women with BMI<30 kg/m2. In active women, TP (g/kg/BW) was positively associated with LS BMD and FN BMC changes.

Conclusions: This study suggests detrimental associations between protein intake and bone health. However, these negative associations maybe counteracted by BMI>30 kg/m2 and physical activity.

Keywords: Dietary protein intake; body mass index; bone mineral density; physical activity; source of protein intake.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Absorptiometry, Photon / methods
  • Aged
  • Aged, 80 and over
  • Animals
  • Body Mass Index*
  • Bone Density / drug effects*
  • Bone and Bones / drug effects*
  • Bone and Bones / metabolism
  • Calcium, Dietary / pharmacology
  • Cholecalciferol / pharmacology
  • Cross-Sectional Studies
  • Diet*
  • Dietary Proteins / administration & dosage
  • Dietary Proteins / adverse effects*
  • Dietary Proteins / pharmacology
  • Dietary Supplements
  • Energy Intake
  • Exercise*
  • Female
  • Fractures, Bone / etiology
  • Fractures, Bone / metabolism
  • Fractures, Bone / prevention & control
  • Humans
  • Osteoporosis, Postmenopausal / etiology*
  • Osteoporosis, Postmenopausal / metabolism
  • Osteoporosis, Postmenopausal / prevention & control
  • Prospective Studies
  • Regression Analysis
  • Surveys and Questionnaires


  • Calcium, Dietary
  • Dietary Proteins
  • Cholecalciferol