What is the evidence for the ketogenic diet's impact on osteoporosis (degenerative bone disease)?

From the Guidelines

The current evidence does not support a direct link between ketogenic diets and degenerative bone disease, but it does suggest that long-term adherence to such diets may increase the risk of bone mineral density loss and fractures in certain individuals, particularly those with pre-existing bone concerns or risk factors, as noted in studies such as 1.

Key Considerations

• The potential for bone health issues with ketogenic diets is a concern due to altered acid-base balance and possible inadequate intake of calcium, vitamin D, and magnesium.
• Supplementation with calcium (1000-1200mg daily), vitamin D3 (1000-2000 IU daily), and magnesium (300-400mg daily) may be beneficial for individuals on long-term ketogenic diets, as suggested by guidelines for managing osteoporosis in gastrointestinal diseases 1.
• Regular weight-bearing exercise is crucial for maintaining bone density, and individuals with existing bone concerns, postmenopausal women, and older adults should be cautious with long-term ketogenic diets and consider periodic bone density monitoring.

Management and Prevention

• A balanced approach to managing bone health, including lifestyle changes, supplementation, and monitoring, is essential for individuals on ketogenic diets, as outlined in guidelines for osteoporosis management in cancer survivors 1.
• Personalized screening strategies, such as using FRAX, and discussions about healthy lifestyle behaviors, including diet, exercise, and smoking cessation, can help mitigate the risk of bone loss and fractures.
• Pharmacologic interventions, such as bisphosphonates, may be considered for individuals at high risk of fracture, but the potential benefits and risks should be carefully discussed, as noted in studies such as 1.

From the Research

Ketogenic Diet and Degenerative Bone Disease

• The relationship between the ketogenic diet and bone health has been evaluated in several studies, with mixed results 2, 3, 4.
• A systematic review of published studies found no significant changes in bone mass density (BMD) after following a ketogenic diet, and no significant effect on bone resorption or formation 2.
• However, another study found that the ketogenic diet can protect the articular cartilage and subchondral bone in a rat osteoarthritis model by inhibiting NLRP3 inflammasome activation and reducing inflammation 3.
• A review of the current progress and controversy surrounding the ketogenic diet and β-hydroxybutyrate in osteoporosis suggests that the ketogenic diet may have detrimental effects on bone accumulation and microarchitecture, while β-hydroxybutyrate may have beneficial effects on osteoblastogenesis and osteoclastogenesis 4.
• Other studies have discussed the pros and cons of the ketogenic diet, including its potential benefits for weight loss and diabetes management, but also its potential risks and limitations 5, 6.

Key Findings

• No significant changes in bone mass density (BMD) were observed after following a ketogenic diet 2.
• The ketogenic diet can protect the articular cartilage and subchondral bone in a rat osteoarthritis model 3.
• β-hydroxybutyrate may have beneficial effects on osteoblastogenesis and osteoclastogenesis 4.
• The ketogenic diet may have detrimental effects on bone accumulation and microarchitecture 4.
• High-quality clinical trials are needed to assess the long-term effects and full potential of ketogenic diets in clinical medicine 6.