Epidemiologic studies, taken as a whole, do not satisfactorily describe the chronic impact of low-protein diets. When bone mineral density (BMD) is the primary outcome, most (44–53) but not all (54–58) epidemiologic studies show a positive relationship between protein intake and BMD. Stated another way, most of the epidemiologic evidence shows that when other known dietary factors are controlled, individuals who consume low-protein diets have lower BMD. Using the NHANES III database, we found that in 1882 non-Hispanic white women 50-y-old and older, after adjusting for age and body weight, a low protein intake was associated with a significantly lower hip BMD (53). Similarly, Hannan et al (52) studied 615 participants in the Framingham Osteoporosis Study over a 4-y period and found that lower levels of protein intake were associated with significantly higher rates of bone loss at the hip and spine. Persons in the lowest quartile of protein intake showed the greatest rates of bone loss. These findings are consistent with earlier work of Freudenheim et al, who reported that a low protein intake was associated with greater loss in bone density from the wrist in 35–65-y-old women (44).
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