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Korean J Fam Med > Volume 44(1); 2023 > Article
Kim: Does Changing the Ratio of Dietary Sodium-to-Potassium Intake Affect Bone Mineral Density?
It is well known that various nutritional factors, such as calcium, vitamin D, and iron [1], as well as dietary factors, such as milk intake [2], affect the level of bone mineral density (BMD). It is possible that salt and potassium intake also play an essential role. As a result, it is possible that the ratio of two nutrients, salt and potassium, influences BMD.
In the present issue, Lee et al. [3] investigated the relationship between dietary Na/K ratio and BMD in middle-aged Korean women. The authors found that the dietary Na+/K+ ratio decreased total femur and lumbar spine BMD from Q1 to Q4 (Pvalue for trend: 0.044 for total femur BMD and 0.002 for lumbar spine BMD). Based on the results of this study, a higher dietary Na+/K+ ratio may be linked to lower BMD.
The Na+/K+ ratio is well known to be closely related to hypertension, stroke, and cardiovascular disease [4,5]. A hypothesis regarding the relationship between the Na+/K+ ratio and osteoporosis was proposed implying that the dietary Na+/K+ balance has the potential to affect various health conditions and chronic diseases more than is currently known [6].
However, since the relationship between dietary sodium and potassium intake and BMD shown in this study was only proven in a cross-sectional study, it would be necessary to first establish this hypothesis through a cohort study.



No potential conflict of interest relevant to this article was reported.


1. Kim SM, Kim AS, Ko HJ, Moon H, Choi HI, Song J. Association between bone mineral density and serum iron indices in premenopausal women in South Korea. Korean J Fam Med 2020;41:175-82.
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2. Kim JS, Oh SW, Kim J. Milk consumption and bone mineral density in adults: using data from the Korea National Health and Nutrition Examination Survey 2008-2011. Korean J Fam Med 2021;42:327-33.
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3. Choi SS, Kim YA, Kim HJ, Cho YJ, Lee GH. The relationship between dietary Na/K ratio and bone mineral density in Korean middle-aged women. Korean J Fam Med 2023;44:21-7.
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4. Mirmiran P, Bahadoran Z, Nazeri P, Azizi F. Dietary sodium to potassium ratio and the incidence of hypertension and cardiovascular disease: a population-based longitudinal study. Clin Exp Hypertens 2018;40:772-9.
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5. Willey J, Gardener H, Cespedes S, Cheung YK, Sacco RL, Elkind MS. Dietary sodium to potassium ratio and risk of stroke in a multiethnic urban population: the Northern Manhattan Study. Stroke 2017;48:2979-83.
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6. Adrogué HJ, Madias NE. Sodium and potassium in the pathogenesis of hypertension. N Engl J Med 2007;356:1966-78.
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