Abstract
This mini-review summarizes the available information regarding the impact of caloric restriction (CR) and/or intermittent fasting (IF) on bone health. CR and IF are dietary interventions used in rehabilitative healthcare for augmenting weight loss and also proposed for recovery of conditions such as stroke and heart failure. CR restricts the total number of calories rather than different food groups or periods of eating. In contrast, IF severely restricts caloric intake for a period of time followed by a period of ad libitum intake. Here, we discuss the available information regarding the impact of these rehabilitation diets on bone metabolism, highlighting areas of consistency and discrepancy and suggesting future areas of study to advance the understanding of CR and/or IF on bone health.
Highlights
Osteoporosis is a chronic condition characterized by low bone mass and places individuals at increased risk for fracture
Numerous studies indicate that caloric restriction (CR) and/ or intermittent fasting (IF), which have been proposed to augment rehabilitation for such conditions as stroke, cardiomyopathy, and heart failure[6,7,8,9], may negatively impact bone health[10,11,12]
Leading to weight loss, this intervention did not impact bone mineral density or serum bone turnover markers[26]. This is generally consistent with a study involving 25% caloric restriction in overweight individuals that showed no change in bone mineral density, though this study reported changes in certain bone turnover markers[27]
Summary
Osteoporosis is a chronic condition characterized by low bone mass and places individuals at increased risk for fracture. Compared to mice fed ad libitum, calorie-restricted mice displayed impaired skeletal growth resulting in smaller body size and low bone mass These changes were associated with reduced bone formation rate with increased bone resorption rate and decreased levels of serum leptin and IGF-1. Clayton et al examined how fasting for twenty-four hours affects bone turnover markers in humans during the re-feeding period and found no impact on bone turnover markers between fasting and control subjects[30] This is generally consistent with Barnosky et al in which they compared six months of alternate-day fasting compared to caloric restriction on bone metabolism in obese adults. This study did not include an assessment of bone mineral density and it is unclear if this effect is due to caloric restriction, sleep disturbance, or other factors such as alteration in mineral intake with evening serum calcium significantly higher during Ramadan[32]
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