Effects of Lemon Beverage Containing Citric Acid with Calcium Supplementation on Bone Metabolism and Mineral Density in Postmenopausal Women: Double-Blind 11-Month Intervention Study

Hiromi Ikeda,Satomi Aoi,Tadayuki Iida,Miho Kanazashi,Toshihide Harada,Takashi Inoue,Masanori Hiramitsu,Fumiko Ishizaki,Toshikazu Suzuki

doi:10.1155/2021/8824753

Hiromi Ikeda, Satomi Aoi + Show 7 more

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https://doi.org/10.1155/2021/8824753

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Abstract

A critical factor for preventing osteoporosis after menopause is attenuation of the accelerated turnover rate of bone metabolism. The present randomized controlled study was conducted to clarify the effects of a lemon beverage with calcium (Ca) supplementation that makes use of the chelating action of citric acid. Comprehensive evaluations of bone were performed by assessments of bone mineral density (BMD) and biomarkers related to bone turnover. Seventy-nine postmenopausal women were enrolled and asked to participate in an 11-month continuous intake of the test beverages. The subjects were divided into three groups: those who consumed a lemon beverage containing citric acid with Ca supplementation (LECA group), those who consumed a lemon beverage containing citric acid without Ca supplementation (LE group), and those who consumed no test beverage (control group). Using a double-blind protocol, subjects in the LECA and LE groups consumed one bottle containing 290 mL of the test beverage each day. The ratio of change in BMD after 11 months was significantly higher in the LECA group as compared to the control and LE groups. The LECA group also showed significant decreases in concentrations of tartrate-resistant acid phosphatase 5b (TRACP-5b), a bone resorption marker, and bone alkaline phosphatase (BAP) as compared to the other groups, as well as a significant decrease in concentration of osteocalcin (OC), a bone formation marker, as compared to the LE group. Based on our findings, we speculated that bone resorption and bone formation in postmenopausal women might be suppressed along with an increase in Ca resorption caused by chelation of citric acid in association with continuous ingestion of a Ca-supplemented lemon beverage containing citric acid, resulting in suppression of high bone metabolic turnover. In addition, the results provide information regarding BMD maintenance in the bones of the trunk, including the lumbar spine and proximal femur.

Highlights

Hiromi Ikeda,1 Tadayuki Iida,1 Masanori Hiramitsu,2 Takashi Inoue,2 Satomi Aoi,1 Miho Kanazashi,1 Fumiko Ishizaki,3 and Toshihide Harada1
We speculated that bone resorption and bone formation in postmenopausal women might be suppressed along with an increase in Ca resorption caused by chelation of citric acid in association with continuous ingestion of a Ca-supplemented lemon beverage containing citric acid, resulting in suppression of high bone metabolic turnover
Introduction e incidence of osteoporosis is exceptionally high in postmenopausal women, as a low estrogen level associated with menopause can lead to insufficient suppression of bone resorption. e result is increased bone resorption and decreased bone mass, resulting in postmenopausal osteoporosis [1], while related osteoporotic fractures are associated with a higher risk of mortality [2]

Summary

Introduction

We speculated that bone resorption and bone formation in postmenopausal women might be suppressed along with an increase in Ca resorption caused by chelation of citric acid in association with continuous ingestion of a Ca-supplemented lemon beverage containing citric acid, resulting in suppression of high bone metabolic turnover. Ose findings indicated that citric acid in lemon possibly stimulates Ca resorption, resulting in suppression of increased bone metabolism and maintenance of BMD in the lumbar spine. Rebecca et al [17] reported that hip, vertebrae, forearm, and wrist fracture rates in subjects receiving supplementation with Ca carbonate (up to 1000 mg/day) and vitamin D (up to 600 IU/ day) were not significant as compared to the placebo group Those reports noted increased risk of kidney stones in association with Ca intake. Those reports noted increased risk of kidney stones in association with Ca intake. ese findings are in contrast to the effects of Ca intake on trunk bone fractures; a more comprehensive understanding of prefracture bone mineral density and the effects of Ca on bone metabolism is needed, while its impact on increased risk of kidney stones must be considered

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