Keywords
osteoporosis - potassium - bone health - dietary guidelines - supplementation - epidemiology
Introduction
Osteoporosis is a systemic skeletal disorder characterized by low bone mass,
structural deterioration of bone tissue, and an increased susceptibility to
fractures. It is a major global health concern, particularly as the aging population
continues to grow [1]. Osteoporosis is often
referred to as the “silent disease” because it progresses without
symptoms until a fracture occurs. The primary hallmark of osteoporosis is reduced
bone density and altered bone microarchitecture, leading to bones becoming fragile
and prone to fractures, especially in the hip, spine, and wrist [2].
Epidemiology
Osteoporosis is a global health issue affecting both men and women. According to
the International Osteoporosis Foundation, it is estimated that worldwide, one
in three women over the age of 50 and one in five men will experience an
osteoporotic fracture during their lifetime. The prevalence of osteoporosis
varies across regions, with higher rates observed in postmenopausal women and
the elderly [3]
[4].
Causes and Risk Factors
Osteoporosis results from an imbalance in bone remodeling, a continuous process
involving bone resorption by osteoclasts and bone formation by osteoblasts.
Several factors contribute to this imbalance [5]
[6]
[7]:
-
Aging: Osteoporosis is more common in older adults due to the natural
aging process, which leads to decreased bone density.
-
Hormonal Changes: Postmenopausal women are at a higher risk of
osteoporosis due to a decline in estrogen levels, which plays a crucial
role in bone health.
-
Genetics: A family history of osteoporosis can increase one’s
risk.
-
Nutrition: Inadequate intake of calcium and vitamin D can impair bone
formation and maintenance.
-
Physical Activity: Sedentary lifestyles contribute to bone loss while
weight-bearing exercise helps maintain bone density.
-
Medications and Health Conditions: Certain medications (e. g.,
glucocorticoids) and health conditions (e. g., rheumatoid
arthritis) can increase osteoporosis risk.
Diagnosis
Accurate diagnosis is crucial for effective management. The cutting-edge
diagnostic tools to detect fractures and osteoporosis with advanced technology
include ([Fig. 1]).
Fig. 1 Advanced technologies for fracture and osteoporosis
detection.
-
Bone Density Testing: Dual-energy X-ray absorptiometry (DXA) scans
measure bone mineral density and are used for diagnosis. Bone
densitometry is a reliable method to know the prognosis of osteoporotic
conditions. It is conventional to use either of the methods to calculate
and diagnose the osteoporotic condition which is T-Score or Z-Score.
T-Score is where standard deviations are compared with a young healthy
individual’s mean bone density [4]. Z-Score is calculated by comparing standard deviations
with mean bone mineral density of individuals of identical age, gender
and size [8]. World Health
Organization suggested T Score or Z Score value – 1.0 to
– 2.5 as low mineral density indicating osteopenia and
below – 2.5 indicates porous bone that may tend to
fracture, that is, osteoporosis [9]
[10].
-
Fracture Risk Assessment: FRAX (Fracture Risk Assessment Tool) calculates
the ten-year risk of hip and major osteoporotic fractures. For the
detection of fractures suggested technology of use is Dual Energy X-ray
Absorptiometry. Another technique to know bone mass is high-resolution
computed tomography. Ultrasound can predict the fracture by diagnosing
the bone firmness [9]. A bone
biopsy is another method to determine the occurrence of osteoporosis
[10].
-
Change in Biomarkers: Serum osteocalcin and bone-specific alkaline
phosphatase serve as indicators of bone formation, whereas urinary type
I collagen C-telopeptide and urinary pyridinoline and deoxypyridinoline
serve as indicators of bone resorption. Alterations in these biomarkers
are linked to rapid bone loss. Strontium absorption tests determine
calcium absorption through the intestine [8]
[9].
-
Clinical Evaluation: A comprehensive assessment of medical history and
risk factors helps identify those at risk [11].
Prevention
Preventing osteoporosis is essential, and lifestyle modifications can
significantly reduce the risk [12]
[13]
[14]:
-
Diet: Adequate calcium and vitamin D intake through diet or supplements
is crucial.
-
Physical Activity: Weight-bearing exercises help maintain bone density
and strength.
-
Lifestyle Choices: Avoiding smoking and excessive alcohol consumption can
reduce osteoporosis risk.
-
Medication: In some cases, medication may be prescribed to prevent or
treat osteoporosis.
Treatment
Several medications are available for osteoporosis management [15]
[16]
[17]:
-
Bisphosphonates: Alendronate, risedronate, and others inhibit bone
resorption.
-
Hormone Replacement Therapy (HRT): Estrogen therapy can help maintain
bone density in postmenopausal women.
-
Denosumab: A monoclonal antibody that reduces bone resorption.
-
Teriparatide and Abaloparatide: Anabolic agents that stimulate bone
formation.
-
Calcitonin: Reduces bone resorption and may be used for pain relief.
-
Emerging Therapies: Novel treatments are under investigation, including
sclerostin inhibitors and romosozumab.
Potassium and Bone Health
Potassium and Bone Health
Mechanisms of Action
Potassium is an essential mineral known primarily for maintaining electrolyte
balance and cardiovascular health. However, emerging evidence suggests that
potassium may have a positive impact on bone health through several mechanisms
[18].
Potassium’s Role in Acid-Base Balance and Bone Buffering
Potassium plays a critical role in maintaining acid-base balance in the body. It
acts as an alkaline buffer by neutralizing excess acid, which is produced during
metabolic processes. This acid-base balance is intimately connected with bone
health [19].
Recent studies have highlighted the following key points:
-
Acidosis and Bone Resorption: Acidosis, characterized by elevated blood
acidity, has been associated with increased bone resorption. The body
releases calcium from bones to neutralize excess acid, potentially
leading to reduced bone density [20]. Frassetto et al., found that reducing dietary acid load
through increased potassium intake can mitigate bone loss [21].
-
Potassium’s Alkaline Effect: Potassium-rich foods, such as fruits
and vegetables, have an alkalizing effect on the body. Alkaline diets
have been linked to a lower risk of osteoporosis. Hannan et al.,
demonstrated that a diet rich in potassium from fruits and vegetables
was associated with a higher bone mineral density (BMD) in older adults
[22].
Influence of Potassium on Bone Turnover Markers
Potassium has been shown to influence bone turnover markers, providing insights
into its direct impact on bone remodeling.
-
Serum Alkaline Phosphatase (ALP): Elevated serum ALP levels are
associated with increased bone formation. Dawson-Hughes et al., reported
that higher potassium intake was positively associated with lower serum
ALP levels, suggesting a potential role in regulating bone formation
[23].
-
Markers of Bone Resorption: Potassium’s alkaline properties may
also affect markers of bone resorption. Macdonald et al., illustrated
that increased fruit and vegetable consumption, rich in potassium, was
associated with lower urinary excretion of markers of bone resorption
[24].
Interaction with Calcium and Vitamin D in Bone Remodeling
Potassium’s interaction with calcium and vitamin D is crucial for bone
health.
-
Calcium Absorption: Adequate potassium levels may enhance calcium
absorption in the intestines. Lu et al. showed that potassium
supplementation improved calcium retention, potentially promoting bone
health [25].
-
Vitamin D Activation: Potassium may also play a role in vitamin D
metabolism. Research carried out by Kim et al., suggests that potassium
may influence the conversion of vitamin D to its active form, which is
essential for calcium absorption and bone remodeling [26].
A simplified representation of the mechanisms of potassium in osteoporosis is
illustrated in [Fig. 2].
Fig. 2 Mechanisms of potassium in osteoporosis.
Cellular Mechanisms
The cellular mechanisms underlying osteoporosis involve a delicate balance
between bone formation by osteoblasts and bone resorption by osteoclasts.
Emerging research suggests that potassium, an essential mineral, plays a
significant role in regulating these cellular processes in bone tissue.
Effects of Potassium on Osteoblasts and Osteoclasts
Recent studies have demonstrated that potassium levels can modulate the activity
of both osteoblasts and osteoclasts, thereby affecting bone health. Potassium
exerts its effects through potassium channels present on the cell membranes of
these bone cells [18].
Potassium Channels in Bone Cells
Potassium channels, specifically the inwardly rectifying potassium (Kir) channels
and voltage-gated potassium (Kv) channels, have been identified in osteoblasts
and osteoclasts. These channels are involved in regulating membrane potential
and intracellular calcium levels, which are crucial for cellular functions [19].
-
Osteoblasts: High extracellular potassium concentrations have been shown
to enhance the differentiation and mineralization of osteoblasts.
Activation of Kir channels in osteoblasts can lead to membrane
hyperpolarization, triggering calcium influx and promoting osteoblast
maturation [3].
-
Osteoclasts: In contrast, increased extracellular potassium levels
inhibit osteoclast activity. High potassium concentrations can
hyperpolarize osteoclasts, reducing their resorptive capacity. This
effect is mediated through voltage-gated potassium channels, which
influence calcium signaling in osteoclasts [16].
The Role of Potassium in Collagen Synthesis
Collagen is a major component of the bone matrix and is essential for bone
strength. Potassium has been linked to collagen synthesis in osteoblasts.
Research suggests that optimal potassium levels are necessary for collagen
production, contributing to bone quality and integrity [16]
[18].
Epidemiological Evidence
Epidemiological studies have provided supportive evidence for the role of potassium
in osteoporosis prevention [16]. Li et al.,
reported that higher dietary potassium intake was associated with increased bone
mineral density (BMD) in postmenopausal women [27]. In another study Larsson et al., showed that potassium-rich diets
were associated with a lower risk of osteoporotic fractures in elderly men [28].
Population Studies
Population studies play a crucial role in understanding the relationships between
dietary factors and bone health.
Correlations Between Dietary Potassium Intake and Bone Mineral Density
(BMD) Several population-based studies have investigated the association
between dietary potassium intake and BMD:
-
NHANES III Study: The National Health and Nutrition Examination
Survey III found that higher dietary potassium intake was positively
associated with BMD in older adults [29]. Increased potassium intake was linked to higher spine
and hip BMD, indicating a potential protective effect on bone
density.
-
The Framingham Osteoporosis Study: Research from this longitudinal
cohort study revealed that higher dietary potassium intake was
associated with greater hip BMD in older men and women [30]. These findings suggest a
potential role for potassium in preserving bone health with age.
Longitudinal Studies on Potassium-Rich Diets and Fracture Risk
Population-based longitudinal studies have explored the relationship between
potassium-rich diets and fracture risk:
-
The Nurses’ Health Study: This prospective cohort study
found that postmenopausal women with higher potassium intake had a lower
risk of hip fractures [31]. The
protective effect of potassium was particularly evident in women who
consumed diets rich in fruits and vegetables.
-
The Osteoporotic Fractures in Men (MrOS) Study: In this study of
older men, those with higher dietary potassium intake had a reduced risk
of hip fractures [32] The results
support the notion that potassium-rich diets can contribute to fracture
prevention in both genders.
Impact of Potassium on Bone Health Across Different Age Groups
Understanding the effects of potassium on bone health across various age groups
is essential:
-
Adolescents and Young Adults: A cross-sectional study conducted by
Whiting et al., indicated that higher dietary potassium intake was
associated with greater bone mass in adolescents. This suggests that
potassium-rich diets during youth may contribute to optimal peak bone
mass [33].
-
Elderly Populations: Research from Harding et al., demonstrated
that higher potassium intake was associated with reduced risk of hip
fractures in older women. These findings underscore the importance of
potassium in maintaining bone health in the elderly [34].
Clinical Trials
Potassium Supplementation and Bone Health Outcomes
Clinical trials have examined the impact of potassium supplementation on bone
health outcomes, with promising results. A randomized controlled trial
carried by Dawson-Hughes et al., investigated the effects of potassium
bicarbonate supplementation on bone mineral density (BMD) in postmenopausal
women. The study found that potassium supplementation led to significant
improvements in BMD at the lumbar spine [29]. Another clinical trial conducted by Orchard et al., explored
the effects of potassium citrate supplementation in individuals with
osteopenia. The results indicated that potassium citrate supplementation was
associated with reduced bone resorption and improved bone microarchitecture
[35]. A randomized controlled
trial conducted by Nasri et al., investigated the effects of potassium
supplementation on bone health in postmenopausal women. The study found that
daily potassium supplementation led to improved bone mineral density (BMD)
at the lumbar spine and hip over a one-year period. This suggests that
potassium supplementation may have a positive impact on bone density [36].
Potassium-Rich Diets and Bone Density Changes
Clinical trials have assessed the relationship between potassium-rich diets
and changes in bone density. A study carried by Wu et al., examined the
dietary potassium intake of elderly women and its association with changes
in BMD over time. The research suggested that higher dietary potassium
intake was linked to slower BMD decline, supporting the potential benefits
of potassium-rich diets in preserving bone density [37]. In a prospective cohort study
reported Macdonald et al., researchers assessed the relationship between
dietary potassium intake and bone health. The study included a large sample
of postmenopausal women and found a positive association between higher
dietary potassium intake and increased BMD at the hip and lumbar spine.
These findings suggest that potassium-rich diets may support bone density
maintenance [38].
Combination Therapy with Potassium, Calcium, and Vitamin D
Clinical trials have explored combination therapies involving potassium,
calcium, and vitamin D for optimizing bone health. A clinical trial reported
by Saadi et al. investigated the effects of a combination therapy involving
calcium, vitamin D, and potassium citrate in postmenopausal women. The study
demonstrated that this combination therapy had a positive impact on BMD and
reduced the risk of fractures [39]. A
multicenter randomized trial conducted by Weaver et al. investigated the
effects of combination therapy with potassium, calcium, and vitamin D on
bone health in older adults. The trial demonstrated that participants
receiving the combination therapy exhibited greater improvements in BMD
compared to those receiving calcium and vitamin D alone. This highlights the
potential synergistic effects of potassium when combined with other
bone-boosting nutrients [40].
The findings from these clinical trials have significant therapeutic
implications for bone health. Potassium supplementation, particularly in the
form of potassium citrate or potassium bicarbonate, may offer a
non-pharmacological approach to enhance bone mineral density in
postmenopausal women and individuals with osteopenia. Encouraging
potassium-rich diets may be a simple and accessible strategy for preserving
bone density in aging populations. Combination therapies involving
potassium, calcium, and vitamin D may have synergistic effects on bone
health, reducing the risk of fractures and improving bone
microarchitecture.
Dietary Guidelines
Diet plays a crucial role in maintaining bone health and overall well-being. In
addition to calcium and vitamin D, potassium is an essential nutrient that has
garnered attention for its potential role in preventing osteoporosis and maintaining
overall health. This article explores dietary guidelines related to potassium
intake, potassium-rich foods, and the importance of balancing potassium and sodium
intake, supported by recent evidence [41].
Recommendations for Potassium Intake in Osteoporosis Prevention
The recommended daily intake of potassium varies by age, sex, and individual
health status. However, there are general guidelines provided by health
organizations, such as the World Health Organization (WHO) and the U.S.
Department of Agriculture (USDA). These guidelines typically recommend a daily
intake of around 4700 milligrams (mg) of potassium for adults [41]
[42]
[43].
Recent evidence has shown that maintaining adequate potassium intake can be
beneficial for bone health and may contribute to osteoporosis prevention. A
study carried by Li et al., found that higher dietary potassium intake was
associated with increased bone mineral density (BMD) in postmenopausal women,
suggesting that meeting recommended potassium levels may support bone health
[27].
Potassium-Rich Foods and Their Role in Bone Health
Consuming potassium-rich foods is an effective way to meet daily potassium
requirements and support bone health. Key potassium-rich foods include [43]
[44]:
-
Fruits: Bananas, oranges, and avocados are rich sources of
potassium. These fruits not only provide essential potassium but also
contain other nutrients, such as vitamin C and folate, which contribute
to overall bone health.
-
Vegetables: Spinach, sweet potatoes, and tomatoes are examples of
vegetables high in potassium. They are also packed with vitamins and
minerals like vitamin K, which plays a crucial role in bone
metabolism.
-
Legumes: Beans, lentils, and peas are excellent sources of
potassium and provide protein and dietary fiber, which are beneficial
for bone health.
-
Dairy Products: Dairy items like yogurt and milk contain potassium
along with calcium, which is vital for maintaining strong bones.
Balancing Potassium and Sodium Intake for Overall Health
Maintaining a proper balance between potassium and sodium (salt) intake is
essential for overall health, as both minerals have significant impacts on heart
health and blood pressure regulation. High sodium intake is associated with
hypertension, which can increase the risk of heart disease and stroke. Recent
studies emphasize the importance of reducing sodium intake and increasing
potassium intake to mitigate these risks [45].
A potassium-rich diet can help counteract the negative effects of excess sodium
by promoting healthy blood pressure levels. In fact, the Dietary Approaches to
Stop Hypertension (DASH) diet, which is high in potassium-rich foods and low in
sodium, has been shown to reduce blood pressure and improve overall
cardiovascular health [46].
Potassium Supplementation
Potassium Supplementation
Potassium is an essential mineral that plays a crucial role in various bodily
functions, including maintaining proper nerve and muscle function, regulating heart
rhythm, and balancing fluid levels. Supplementation with potassium may be necessary
in certain situations, particularly for at-risk populations and older adults.
Potassium Supplements for At-Risk Populations
-
Hypokalemia Risk: Potassium supplementation is often recommended
for individuals at risk of hypokalemia, which is a condition
characterized by low potassium levels in the blood. At-risk populations
may include people with kidney disease, certain gastrointestinal
disorders (e. g., chronic diarrhea), and those taking specific
medications such as diuretics, which can lead to potassium loss [47].
-
Recommended Dosage: The appropriate dosage of potassium
supplements varies depending on individual needs and medical conditions.
Typically, healthcare providers prescribe potassium supplements in the
form of tablets or capsules, with dosages ranging from 20 mEq to 100 mEq
per day. However, the dosage should be determined by a healthcare
professional after considering the patient’s specific
circumstances [48]
[49].
-
Forms of Potassium Supplements: Common forms of potassium
supplements include potassium chloride, potassium citrate, and potassium
gluconate. The choice of supplement depends on factors like the
patient’s tolerance, the presence of underlying conditions, and
the potential for drug interactions [49]
[50].
Considerations for Supplementation in Older Adults
-
Age-Related Changes: Older adults may be at an increased risk of
potassium deficiency due to age-related changes in kidney function and
reduced dietary intake. Therefore, they may benefit from potassium
supplementation to maintain healthy potassium levels [50].
-
Caution with Medications: Older adults are more likely to be
taking medications that can interfere with potassium levels, such as
diuretics or certain blood pressure medications. Healthcare providers
should carefully consider the interaction between these drugs and
potassium supplements to avoid adverse effects [51].
-
Individualized Assessment: Supplementation in older adults should
be individualized and based on their specific health status, dietary
habits, and medication use. Regular monitoring of potassium levels is
essential to prevent both deficiency and excess [52]
[53].
Monitoring Potassium Levels and Potential Side Effects
-
Regular Blood Tests: People who are prescribed potassium
supplements should undergo regular blood tests to monitor their
potassium levels. This is crucial to ensure that supplementation is
effective but not leading to hyperkalemia (excess potassium in the
blood) [51]
[52].
-
Potential Side Effects: Excessive potassium intake can lead to
hyperkalemia, which can cause muscle weakness, irregular heart rhythms,
and in severe cases, cardiac arrest. Therefore, it is essential to
monitor for symptoms of hyperkalemia and adjust the dosage as needed
[47]
[54].
-
Consultation with Healthcare Provider: Anyone considering
potassium supplementation, especially those with underlying health
conditions, should consult with a healthcare provider who can provide
guidance on the appropriate dosage and monitor for any adverse effects
[55].
Interdisciplinary Approaches in Management and Prevention of Osteoporosis
Interdisciplinary Approaches in Management and Prevention of Osteoporosis
Interdisciplinary approaches have gained prominence in managing and preventing
osteoporosis as they leverage the expertise of various healthcare professionals to
address the multifactorial nature of the condition. The present review delves into
three key interdisciplinary approaches in osteoporosis prevention:
Collaborative Efforts between Nutritionists, Endocrinologists, and Bone
Specialists
Nutrition plays a pivotal role in bone health, and collaborative efforts among
nutritionists, endocrinologists, and bone specialists can provide comprehensive
care for individuals at risk of osteoporosis. Nutritionists can assess dietary
intake and formulate personalized nutrition plans to optimize calcium and
vitamin D intake, which are critical for bone health. Endocrinologists can
identify hormonal imbalances that may contribute to bone loss, such as hormonal
deficiencies or excesses, while bone specialists can evaluate bone density and
assess fracture risk [27]. A study
reported by Ceglia et al., demonstrated that collaborative care involving
nutritionists, endocrinologists, and bone specialists resulted in significant
improvements in bone health markers in postmenopausal women [56].
Personalized Nutrition Plans for Osteoporosis Prevention
Personalized nutrition plans tailored to an individual’s specific needs
and risk factors can be highly effective in osteoporosis prevention. These plans
consider factors such as age, gender, dietary preferences, and existing medical
conditions. They aim to optimize calcium and vitamin D intake, as well as other
nutrients like potassium, magnesium, and protein. Additionally, dietary plans
may consider the avoidance of excessive sodium and caffeine consumption, as they
can contribute to bone loss. A meta-analysis carried by Tang et al., concluded
that personalized dietary interventions had a positive impact on bone mineral
density, particularly in postmenopausal women [57].
Addressing the Potassium-Calcium Balance in Dietary Guidelines
Potassium and calcium are vital minerals for bone health, and maintaining an
appropriate balance between them is crucial. High sodium intake, which is common
in many Western diets, can lead to excessive calcium excretion in the urine and
increase the risk of osteoporosis. Interdisciplinary teams can work together to
develop dietary guidelines that emphasize potassium-rich foods (e. g.,
fruits and vegetables) and recommend reducing sodium intake to improve the
potassium-calcium balance. A study conducted by Tucker et al., 1999 found that a
higher dietary potassium-calcium ratio was associated with a lower risk of
osteoporosis-related fractures in older adults [30].
Limitations of Current Research
Limitations of Current Research
Variability in Study Methodologies and Populations
Numerous studies examining the association between potassium intake and bone
health have employed different methodologies, including cross-sectional studies,
cohort studies, and randomized controlled trials (RCTs). These studies often
have varying methodologies for assessing potassium intake and bone health
outcomes. For example, a meta-analysis performed by Lanham-New et al. found
significant heterogeneity among studies investigating the association between
dietary potassium intake and bone mineral density, highlighting the variability
in methodologies and populations [58].
Variability in study designs and methodologies can lead to inconsistent findings
and make it difficult to draw definitive conclusions about the relationship
between potassium intake and bone health [59].
The Need for Randomized Controlled Trials (RCTs)
While there is evidence from observational studies suggesting a positive
association between higher potassium intake and better bone health, the gold
standard for establishing causation is RCTs. RCTs involve randomly assigning
individuals to different levels of potassium intake and observing the impact on
bone health outcomes. RCTs help control for confounding variables and provide
stronger evidence for causation [60].
Identifying the optimal range of potassium intake that promotes bone health
without causing harm requires more research, including RCTs and long-term
studies. A meta-analysis reported by Lambert et al. concluded that both low and
high potassium intakes may be associated with a higher risk of osteoporosis,
emphasizing the need for further research to determine optimal levels [61]. The scarcity of RCTs specifically
designed to assess the effects of potassium supplementation on bone health
limits our ability to make definitive conclusions regarding the causal
relationship.
Identifying Optimal Potassium Levels for Bone Health
There is a lack of consensus regarding the optimal level of potassium intake for
promoting bone health. Some studies suggest that higher potassium intake is
associated with improved bone density and reduced risk of fractures, while
others find no significant association or even potential adverse effects at very
high potassium levels. Optimal potassium levels may vary depending on an
individual’s overall diet and other factors [62]. The lack of a clear consensus on the
optimal potassium intake for bone health makes it challenging to provide
specific dietary recommendations.
Potential Risks
Monitoring potassium levels in individuals with renal issues and balancing potassium
intake with medications are important considerations in healthcare to prevent
potential risks associated with potassium imbalances.
Monitoring Potassium Levels in Individuals with Renal Issues
Potassium is an essential mineral that plays a critical role in various bodily
functions, including nerve function, muscle contractions, and maintaining heart
rhythm. However, the kidneys are responsible for regulating potassium levels in
the body by excreting excess potassium through urine. In individuals with renal
(kidney) issues, such as chronic kidney disease (CKD), the kidneys may not
function properly, leading to a potential risk of high potassium levels in the
blood (hyperkalemia). Hyperkalemia can have serious consequences, including
cardiac arrhythmias and muscle weakness, which can be life-threatening if not
properly managed [63]
[64].
Balancing Potassium Intake with Medications
Some medications can affect potassium levels in the body. For example, certain
medications, like potassium-sparing diuretics (e. g., spironolactone),
can increase potassium levels, while others, like certain diuretics
(e. g., furosemide), can decrease potassium levels. It is crucial to
balance dietary potassium intake with medications to prevent either hyperkalemia
(high potassium) or hypokalemia (low potassium). Imbalances in potassium levels
can lead to adverse health effects. High potassium levels can cause heart rhythm
disturbances, and low potassium levels can result in muscle weakness and
irregular heartbeat [65]
[66].
Future Research Areas
Potassium is an essential mineral in the human body, primarily known for its role
in
maintaining electrolyte balance and regulating blood pressure. However, emerging
evidence suggests that potassium may also play a significant role in bone health by
influencing bone microarchitecture, including bone density and structure. Conducting
longitudinal studies to investigate the association between dietary potassium intake
and bone microarchitecture. These studies could include advanced imaging techniques
like high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess
bone quality. Examining the potential mechanisms through which potassium affects
bone microarchitecture. This might involve in vitro studies using bone cell cultures
to understand the cellular processes involved [67].
Genetic factors can play a crucial role in determining an individual’s
potassium metabolism and, by extension, their bone health. Identifying specific
genes and genetic variations associated with potassium metabolism and bone health
can provide valuable insights into personalized medicine and interventions.
Genome-wide association studies (GWAS) to identify genetic variants associated with
potassium metabolism and bone health outcomes such as bone mineral density and
fracture risk. Investigating gene-environment interactions to understand how genetic
factors and dietary potassium intake interact to influence bone health [68].
To understand how potassium influences bone health at the cellular level, mechanistic
studies are essential. These studies can provide insights into the signaling
pathways and cellular processes involved in potassium’s impact on bone
cells. Conducting in vitro studies using bone cell cultures to investigate how
potassium influences osteoblast (bone-forming cell) and osteoclast (bone-resorbing
cell) activity. This could involve exploring potassium’s effects on cell
proliferation, differentiation, and mineralization [69].
Marketed Products of Potassium
Marketed Products of Potassium
Potassium supplements are available in many salt forms like Potassium gluconate,
Potassium Chloride, Potassium Citrate, Potassium Asporotate, Potassium Iodide,
Potassium Magnesium Citrate, Potassium Magnesium Aspartate, Potassium Bicarbonate
in
various brand names for different indications like Nephrotic stones, hypokalemia,
Hypertension, Arrhythmia, Thallium toxicity, Hyperthyroidism, Sporotrichosis [70]. Potassium bicarbonate cannot be given
orally since it releases carbon dioxide that could impart a deleterious effect on
gastric mucosa [71].
Some Potassium Supplements Products that are Available in the Market
Although the branded products of potassium listed ([Table 1]) below are just a few examples of
potassium supplements, they are also a prescription medication that is available
in tablet, capsule, powder form. Low blood potassium levels are treated or
prevented using this medication. Only use prescription drugs as directed by a
healthcare professional.
Table 1 An overview on marketed products of
potassium.
|
Entry
|
Brand
|
Manufacturer
|
Marketed by
|
Category
|
Dose
|
Dosage form
|
Formulation technology
|
Reference
|
|
1.
|
Klor-Con® (USP)
|
Upsher Smith Laboratories. LLC
|
Upsher Smith Laboratories. LLC
|
Potassium Chloride
|
600 mg, 750 mg
|
ER Tab
|
Wax Matrix Tablet
|
RxList [85]
|
|
2.
|
Klor-Con®M 10/15/20
(USP)
|
Upsher Smith Laboratories. LLC
|
Upsher Smith Laboratories. LLC
|
Potassium Chloride
|
750 mg, 1125 mg, 1500 mg
|
ER Tab
|
ME
|
Dailymed [86]
|
|
3.
|
KCl Cure (I.P.)
|
Pharma Cure Laboratories/Curetech Formulations (P)
Ltd
|
Hargun Biotech
|
Potassium Chloride
|
1500 mg in 10 mL
|
Liquid Injection
|
Not Specified
|
Pharmacure Laboratories [87]
|
|
4.
|
K-TAB (USP)
|
AbbVie LTD
|
AbbVie Inc.
|
Potassium Chloride
|
600 mg, 750 mg, 1500 mg
|
ER Tab
|
Film sealed tablet
|
Food and Drug Administration [88]
|
|
5.
|
Slow-K (USP)
|
Novartis Pharmaceutical Corporation
|
Novartis Pharmaceutical Corporation
|
Potassium Chloride
|
600 mg
|
ER Tab
|
Wax Matrix
|
RxList [89]
|
|
6.
|
Sando-K
|
Alturix Limited
|
Sandoz
|
Potassium Chloride (Ph.Eur.), Potassium Bicarbonate (USP)
|
600 mg+++400 mg
|
ER Tab
|
Not Specified
|
Medicines [90]
|
|
7.
|
Micro-K ExtenCaps (USP)
|
KV Pharmaceutical
|
Ther Rx Corporation
|
Potassium Chloride
|
600 mg, 750 mg
|
ER- HGCap
|
ME
|
RxList [91]
|
|
8.
|
K-Dur (USP)
|
Key Pharmaceuticals Inc.
|
Key Pharmaceuticals Inc.
|
Potassium Chloride
|
750 mg, 1500 mg
|
ER Tab
|
ME
|
Drugs [92]
|
|
9.
|
Urikind-K Oral Solution (USP)
|
Cris Pharma (India) Ltd
|
Mankind Pharmaceuticals
|
Potassium Citrate
|
1100 mg
|
Oral Solution
|
Not Specified
|
1 mg [93]
|
|
10.
|
Urocit-K
|
Mission Pharmaceutical
|
Allmed Labs
|
Potassium Citrate
|
1080 mg
|
ER Tab
|
Wax Matrix Tablets
|
Urocit-K [94]
|
|
11.
|
Bone Up
|
Jarrow Formulas
|
Jarrow Formulas
|
Potassium Citrate
|
99 mg
|
Capsule
|
Not Specified
|
Jarrow [95]
|
|
12.
|
Klotrix
|
Bristol-Myers Squibb Company
|
Bristol-Myers Squibb Company
|
Potassium Chloride
|
750 mg
|
ER Tab
|
Film-Coated Wax-Matrix Tablet
|
Drugs [96]
|
ER Tab: Extended Release Tablets; ER-HG Cap: Extended Release Hard
Gelatin Capsules; ME: Microencapsulation.
Other Products
Twinlab Potassium Caps, Country Life Target-Mins Potassium, Solgar Potassium
Tablets, Nature’s Way Potassium Chelate, Bluebonnet Nutrition Chelated
Potassium, Douglas Laboratories Potassium 99 mg Chelated, Life Extension
Potassium Caps, Solaray Potassium Asporotate, Pure Encapsulations Potassium
Magnesium Citrate, Doctor’s Best High Absorption Magnesium &
Potassium, GNC Potassium Magnesium Aspartate, Now Foods Potassium Citrate
Powder, Himalayan Organics Potassium Citrate Tablets, Jarrows Potassium Citrate
Tablets, Source Naturals Potassium Iodide.
Adverse Reactions, Drug Interactions and Contraindications to Potassium
Supplements
Adverse Reactions, Drug Interactions and Contraindications to Potassium
Supplements
To guarantee the safety and efficacy of the medication, potassium contraindications
or potential drug interactions should be carefully reviewed and assessed prior to
usage. Potassium is contraindicated in hyperkalemia and it tends to interact with
Angiotensin-Converting Enzyme (ACE) Inhibitors, Angiotensin Receptor Blockers (ARBs)
[72] and Potassium-Sparing Diuretics
(Triamterene, Amiloride, Spironolactone) causing hyperkalemia [73], gastrointestinal adverse drug reactions
[74], esophageal obstruction [75], Perforation of Small Bowel [76], ulcer, and stenosis [77].
The National Academies of Sciences describes the Dietary Reference Intakes (DRIs)
for
potassium as guidelines established by the National Academies of Sciences,
Engineering and Medicine to help people maintain a healthy diet and avoid nutrient
deficiencies. The article specifically focuses on the potential toxicity of
potassium, providing recommendations for safe intake levels and potential adverse
effects of consuming too much potassium. Although not consistently, high, acute
potassium intakes have been linked to symptoms of neuromuscular dysfunction such as
weakness, paralysis, nausea, vomiting and diarrhea [78].
Potassium overdose is also related to morbidity as mentioned in one of the case
studies by Guillermo et al., where a deliberate ingestion of 100 extended release
potassium chloride pills, 50 mg of clonazepam, and an unknown quantity of
ethanol by a woman (42 years of age) resulted in hyperlactatemia, metabolic
acidosis, and sinus tachycardia within two hours. No particular procedures were
required after the patient originally received therapy with activated charcoal and
gastric lavage. She did, however, need to have a transcutaneous pacemaker implanted.
Her medical history led to the suspicion of a pharmacobezoar, which was treated with
an endoscopy to eliminate 99 pills of potassium that had developed concretions [79].
Afshar et al., demonstrated that the BALB/c fetal mice developed their eyes
with substantial abnormalities as a result of long-term potassium benzoate
ingestion. The detected consequences included ocular malformations and structural
abnormalities, suggesting that potassium benzoate may be teratogenic. The level of
potassium benzoate exposure and the severity of the anomalies were associated [80].
Safe Dose of Potassium
It seems that adding around 2500 mg/day (64 mmol/day)
of potassium in regular meal for a brief period is not risky for individuals who are
generally in good health [78].
A study conducted Goyal et al., in 2012 revealed that individuals who suffer from
Acute Myocardial Infarction displayed a lower incidence of mortality if their
potassium levels in serum lie within range of 3.5 mEq/l and<4.5
mEq/l conversely to potassium levels that were higher or lower. Therefore,
it is plausible to deduce that healthy serum potassium values may fall within the
range of 3.5 mmol/l and 5.0 mmol/l. Levels that fall
beyond this range could potentially result in death due to various complications
[81].
A reference daily intake (RDI) for potassium is set by the Food and Drug
Administration (FDA). RDI refers to ‘the quantity of a nutrient thought to
be enough to fulfill the needs of most healthy people on a daily basis’.
According to the FDA, potassium RDI is 4700 milligrams per day indicated to
individuals over the age of 14. However, certain populations may require different
amounts, such as pregnant or lactating women [82].
As per National Institute of Health Adequate intake (AI) of potassium recommended
for
14 to 18 years of age is 3000 mg (male) and 2300 mg (female), 19 to
50 years of age and above 3400 (male) 2600 mg (female). For pregnant ladies
of age 14 to 18 years AI of potassium recommended is 2600 mg and 19 to 50
years is 2900 mg whereas for lactating mothers recommended AI for the age
between 14 to 18 years is 2500 mg and for 19 to 50 years is 2800 mg.
This recommended AI is not applicable for patients with any renal condition [83].
Around 90% of the potassium consumed, which amounts to 60–100 mEq, is
eliminated through urine, 10% of the body’s waste is passed in the
stool, and some is lost through perspiration. Despite this, uncertainty exists
regarding the bioavailability of potassium from dietary sources, and its impact on
health outcomes remains largely unknown [84].
Summary and Conclusion
In the ever-evolving landscape of bone health research, potassium emerges as a
frontier with immense potential to reshape our understanding of osteoporosis. The
journey of exploring the role of this essential mineral in bone microarchitecture,
deciphering genetic factors influencing potassium metabolism, and unraveling
mechanistic insights into its effects on bone cells has opened a world of
possibilities. As we navigate the complexities of osteoporosis, the evidence amassed
from studies linking potassium intake to improved bone mineral density and reduced
fracture risk in postmenopausal women and older adults cannot be overlooked. The
tantalizing prospect of potassium as a modifiable dietary factor brings hope for
preventive strategies and personalized interventions. Furthermore, genetics adds a
layer of complexity and intrigue to the potassium-bone health equation. Genetic
factors influence not only our potassium metabolism but also our predisposition to
bone-related disorders. By delving into the genetic determinants of potassium and
bone health, we may unearth the keys to personalized osteoporosis management and
treatment.
Mechanistic studies at the cellular level have unveiled glimpses of how potassium
interacts with bone cells, from osteoblasts to osteoclasts. These investigations
shed light on the intricate molecular pathways that underlie the effects of
potassium on bone remodeling. Such insights hold promise for the development of
targeted therapies that can harness potassium’s potential to strengthen
bones.
In conclusion, the exploration of potassium’s role in osteoporosis represents
an exciting frontier in bone health research. It beckons us to venture further, to
probe deeper, and to seek answers that may ultimately transform the way we approach
osteoporosis prevention and treatment. With continued dedication and scientific
rigor, potassium may well become a cornerstone in our efforts to fortify the
foundations of bone health for generations to come.
