Calvo M S
Department of Health and Human Services, Food and Drug Administration, Washington DC 20204, USA.
Adv Nutr Res. 1994;9:183-207. doi: 10.1007/978-1-4757-9092-4_11.
Survey data confirm that the dietary pattern of many American women who are at high risk of developing osteoporosis is typically high in phosphorus and low in calcium. The imbalance between calcium and phosphorus intake may become more pronounced with continued changes in food preferences and the growing use of phosphorus-containing food additives. Recent studies in young women have shown that a high phosphorus diet moderately low in calcium results in a mild secondary hyperparathyroidism that persists over 4 weeks. Plasma levels of calcitriol did not change despite changes in PTH and serum ionized calcium. Studies on men have shown that dietary phosphorus at levels within the normal range of intakes can affect the renal production and serum concentration of calcitriol. High phosphorus intakes for ten days reduced their plasma calcitriol levels; a 70% reduction in phosphate intake significantly increased their plasma calcitriol. Thus, several lines of evidence indicate that prolonged high phosphorus intake may impair the usual homeostatic mechanisms that come into play when dietary calcium is limited. This, in turn, could impair achievement of maximal bone mass or accelerate bone loss. Although no clinical studies have linked high phosphorus intake with lower bone mass or higher rates of bone loss in humans, this relationship has been demonstrated in animal models. For example, young beagles fed high phosphorus, moderately low calcium diets showed a significant reduction in vertebral bone mass. Current dietary patterns of high phosphorus, low calcium consumption result in persistent changes in calcium regulating hormones that are not conducive to maximizing peak bone mass during growth or slowing the rate of aging bone loss. The net effect of the present dietary pattern on bone status, particularly in teenage and young adult women, needs to be determined. Optimal nutrition early in life, which may include higher calcium and lower phosphorus intakes, together with adequate exercise, may be the most cost-effective approach to the prevention of osteoporotic fractures.
调查数据证实，许多有患骨质疏松症高风险的美国女性的饮食模式通常是磷含量高而钙含量低。随着食物偏好的持续变化以及含磷食品添加剂使用的增加，钙和磷摄入之间的不平衡可能会变得更加明显。最近对年轻女性的研究表明，钙含量适度低的高磷饮食会导致持续4周以上的轻度继发性甲状旁腺功能亢进。尽管甲状旁腺激素（PTH）和血清离子钙发生了变化，但骨化三醇的血浆水平并未改变。对男性的研究表明，在正常摄入范围内的膳食磷水平会影响骨化三醇的肾脏生成和血清浓度。连续十天高磷摄入会降低他们的血浆骨化三醇水平；磷摄入量减少70%会显著提高他们的血浆骨化三醇水平。因此，几条证据表明，长期高磷摄入可能会损害在膳食钙有限时发挥作用的正常稳态机制。反过来，这可能会损害最大骨量的实现或加速骨质流失。虽然尚无临床研究将高磷摄入与人类较低的骨量或较高的骨质流失率联系起来，但这种关系已在动物模型中得到证实。例如，喂食高磷、适度低钙饮食的幼年比格犬的椎骨骨量显著减少。目前高磷、低钙的饮食模式会导致钙调节激素持续变化，这不利于在生长过程中使峰值骨量最大化或减缓衰老骨质流失的速度。目前的饮食模式对骨骼状态的净影响，尤其是对青少年和年轻成年女性的影响，需要确定。生命早期的最佳营养，可能包括较高的钙摄入量和较低的磷摄入量，再加上适当的运动，可能是预防骨质疏松性骨折最具成本效益的方法。
