Is phosphorus intake that exceeds dietary requirements a risk factor in bone health?
Phosphorus intake in excess of the nutrient needs of healthy adults is thought to disrupt hormonal regulation of phosphorus (P), calcium (Ca), and vitamin D, contributing to impaired peak bone mass, bone resorption, and greater risk of fracture. Elevation of extracellular phosphorus due to excessive intake is thought to be the main stimulus disrupting phosphorus homeostasis in healthy individuals, as it is in renal disease even when intake is modest. If high serum phosphorus is the critical link to the effect of high phosphorus intake on bone health, the issue could be addressed through epidemiologic or dietary studies. However, several confounding factors, including problems estimating accurate phosphorus intake, the influence of a low dietary Ca:P ratio, the acidic nature of phosphorus, the rapid rate of absorption and greater phosphorus bioavailability from processed food such as cola drinks, and circadian fluctuation in serum phosphorus, make this question difficult to address using conventional study designs. These confounding factors are considered in this review, exploring whether phosphorus intake exceeding nutrient needs in healthy individuals disrupts phosphorus regulation and negatively affects bone accretion or loss. Specific attention is given to phosphorus intake from processed foods rich in phosphorus additives, which significantly contribute to phosphorus intake.
Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, Laurel, Maryland.
Mona S
MS
Calvo
Katherine L
KL
Tucker
D015519:Bone Density / Q000502:physiology*; D001847:Bone Diseases / Q000453:epidemiology* / Q000378:metabolism; D001862:Bone Resorption / Q000378:metabolism; D001842:Bone and Bones / Q000378:metabolism*; D002118:Calcium / Q000378:metabolism; D000089703:Fibroblast Growth Factor-23; D005503:Food Additives / Q000737:chemistry; D006801:Humans; D010710:Phosphates / Q000097:blood* / Q000378:metabolism; D016226:Phosphorus, Dietary / Q000008:administration & dosage / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000401:mortality
C000717427:FGF23 protein, human; D005503:Food Additives; D010710:Phosphates; D016226:Phosphorus, Dietary; D000089703:Fibroblast Growth Factor-23; D002118:Calcium
Ca:P intake ratio; FGF-23; PRAL; PTH; bone mineral density; bone turnover markers; calcitriol; cola soft drinks; dietary acid load; phosphoric acid; phosphorus food additives; serum phosphorus circadian rhythm