title: Effect of potassium citrate on bone density, microarchitecture, and fracture risk in healthy older adults without osteoporosis: a randomized controlled trial.
abstract: BACKGROUND
  The acid load imposed by a modern diet may play an important role in the pathophysiology of osteoporosis.
  
  
  OBJECTIVE
  Our objective was to evaluate the skeletal efficacy and safety and the effect on fracture prediction of K-citrate to neutralize diet-induced acid loads.
  
  
  METHODS
  We conducted a randomized, double-blind, placebo-controlled trial at a teaching hospital.
  
  
  METHODS
  Subjects included 201 elderly (>65 yr old) healthy men and women (t-score of -0.6 at lumbar spine).
  
  
  METHODS
  Intervention was 60 mEq of K-citrate daily or placebo by mouth. All subjects received calcium and vitamin D.
  
  
  METHODS
  The primary outcome was change in areal bone mineral density (aBMD) at the lumbar spine by dual-energy x-ray absorptiometry after 24 months. Secondary endpoints included changes in volumetric density and microarchitectural parameters by high-resolution peripheral quantitative computed tomography in both radii and both tibiae and fracture risk assessment by FRAX (Switzerland).
  
  
  RESULTS
  K-citrate increased aBMD at lumbar spine from baseline by 1.7 ± 1.5% [95% confidence interval (CI) = 1.0-2.3, P < 0.001] net of placebo after 24 months. High-resolution peripheral quantitative computed tomography-measured trabecular densities increased at nondominant tibia (1.3 ± 1.3%, CI = 0.7-1.9, P < 0.001) and nondominant radius (2.0 ± 2.0%, CI = 1.4-2.7, P < 0.001). At nondominant radius, trabecular bone volume/tissue volume increased by 0.9 ± 0.8%, (CI = 0.1-1.7), trabecular thickness by 1.5 ± 1.6% (CI = 0.7-2.3), and trabecular number by 1.9 ± 1.8% (CI = 0.7-3.1, for all, P < 0.05). K-citrate diminished fracture prediction score by FRAX significantly in both sexes.
  
  
  CONCLUSIONS
  Among a group of healthy elderly persons without osteoporosis, treatment with K-citrate for 24 months resulted in a significant increase in aBMD and volumetric BMD at several sites tested, while also improving bone microarchitecture. Based on the effect on fracture prediction, an effect on future fractures by K-citrate is possible.
authors.affiliation: Department of Medicine, Kantonsspital Bruderholz, University of Basel, CH-4101 Bruderholz/Basel, Switzerland.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Jehle
authors.forename: Henry N
authors.initials: HN
authors.lastname: Hulter
authors.forename: Reto
authors.initials: R
authors.lastname: Krapf
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects* / Q000648:ultrastructure; D004232:Diuretics / Q000494:pharmacology / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006262:Health; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000378:metabolism; D010919:Placebos; D019357:Potassium Citrate / Q000494:pharmacology* / Q000627:therapeutic use; D012307:Risk Factors
chemical_list: D004232:Diuretics; D010919:Placebos; D019357:Potassium Citrate