Recent ‌Study Links Dietary Acid Load To Osteoporosis Risk - Save Our Bones

A cross-sectional study has linked dietary acid load with osteoporosis in postmenopausal women. This finding strongly reinforces the foundational principles of the Save Institute’s 80/20 pH-balanced diet.

In this article, we’ll review the details of that study. You’ll learn about the strengths of cross-sectional studies, the impacts of dietary acid load, and the relationship between diet and bone health.

The study identifies characteristics shared by postmenopausal women who have osteoporosis that are not found in women with stronger bones. You can use this knowledge to change your behaviors, and by doing so, strengthen your bones.

All About The Study

A recent cross-sectional study published in the journal Food Science And Nutrition examined the diets and bone health of postmenopausal women.

In a cross-sectional study, researchers collect data from a wide variety of individuals at a single point in time. Because the data acts like a snapshot, the study process does not influence the behavior of the participants.

This study's participants included 232 postmenopausal women between 50 and 65 years of age. Of those women, 124 had normal bone mineral density (BMD) and 108 were diagnosed with osteoporosis using DXA scans.1

Each participant's dietary acid load was calculated using a semiquantitative food frequency questionnaire that covered the prior year. A semiquantitative food frequency questionnaire collects information about portion sizes, specified either as standardized portions or a choice of a range of portions. This provides more information than a nonquantitative questionnaire, which asks how frequently the participants eat each type of food but not the portion size.

This set of study methods is highly reliable, making this study particularly useful for assessing the impact of diet on osteoporosis.


A recent study of 232 postmenopausal women used DXA scans and semiquantitative food frequency questionnaires to assess the impact of diet on osteoporosis.

About Dietary Acid Load

The key finding in this study linked osteoporosis and a high Dietary Acid Load (DAL).1

When our digestive system breaks down the food we consume, it releases the compounds and molecules that comprise that food. Some compounds will have an acidifying or alkalizing effect on our body; they are acid or alkali precursors.

Our kidneys eliminate excess acid through urine, and the measurement of this excreted acid is called net endogenous acid production (NEAP).

The effect of a specific food or an entire diet on NEAP is called potential renal acid load (PRAL). Every food has a PRAL score that indicates whether it will acidify or alkalize the serum pH. This makes it possible to assess a diet for its impact on dietary acid load.

A diet with a high potential renal acid load (PRAL) score will correlate with a high net endogenous acid production (NEAP) level, which indicates a high Dietary Acid Load (DAL).

The authors of this study used the food frequency questionnaire completed by each participant to assess their PRAL, NEAP, and DAL.


The key finding in this study linked osteoporosis and a high Dietary Acid Load (DAL). DAL was assessed by calculating the potential renal acid load (PRAL) score of each participant's diet. The PRAL score is used to calculate the net endogenous acid production (NEAP) of each diet, which in turn reveals the Dietary Acid Load (DAL).

Differences In Dietary Acid Load Correlated To Osteoporosis

The study authors found that women with osteoporosis had higher PRAL and NEAP scores compared to those with normal bone mineral density (BMD). The researchers noted that the participants with low BMD scores ate a diet that was lower in potassium, magnesium, and calcium than the women with normal BMD.

The likelihood of osteoporosis increased by three percent with a one-unit increase in PRAL score. Those odds increased by four percent with increasing NEAP scores, up to a single unit of change.

The authors' conclusions were extremely clear:

“The risk of osteoporosis was 65% and 72% higher in the women with the PRAL and NEAP scores above the median compared to the group with the scores below the median, respectively. These findings imply that dietary patterns that produce high DAL can have a detrimental effect on bone health.”1

The authors found that high PRAL and NEAP scores correlated with a significantly higher risk of osteoporosis. High Dietary Acid Load has a detrimental effect on bone health.

Dietary pH-Balance Is The Basis Of Bone Strength

The authors of this study validated one of the foundational principles of the Save Institute’s approach to reversing and preventing osteoporosis.

A high dietary acid load weakens bones because the body will remove alkalizing minerals from bone tissue to maintain a healthy pH balance. Without a pH-balanced diet, your bones are under constant assault.

The study authors stated that “a high-acidity diet can increase the risk of osteoporosis and fractures related to decreased bone density, while consumption of alkaline-producing foods can prevent acid-dependent bone loss.”1

This fact is foundational. On it, we can build a diet that supports strong and healthy bones– which is as the Save Institute explains in the program.


High-acidity diets weaken bone, while the consumption of alkaline-producing foods can prevent bone loss. This is the foundation of the Save Institute's approach to a bone-healthy diet.

What This Means To You

This study underscores the importance of a pH-balance diet. The Save Institute built our approach to preventing and reversing osteoporosis around this principle.

We even created a cookbook and meal planner to make it easy and fun to prepare pH-balanced meals. Bone Appétite has the answer for every craving, with more than 200 recipes covering lunch, breakfast, dinner, dessert– even snacks and smoothies!

Adopting a pH-balanced diet doesn’t mean you have to deprive yourself of your favorite foods. It’s all about balance. That means you can eat what makes you feel good and preserve your health and independence for decades to come.



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13 comments. Leave Yours Now →
  1. Chris Jackson

    Hello from the Uk
    I have just been on a ORP for the last year using evenity. It was only endorsed for use here in 2023. I am no longer osteoporotic but have osteopenia! I am now embarked on a 10 injection course of prolia (Denosumab). Of course I have been eating a balanced diet with the help of “Save our Bones”, which I have followed for the last 30 years, along with regular exercise. I am thrilled. I now have the possibility of corrective surgery and my life back. Thank you

  2. Jenny Graves

    I can’t help thinking that a balanced diet, with plenty of protein, calcium-rich foods and enough fruit and vegetables to get the minerals we need is sufficient. And that is backed up in this study – – which says that plenty of protein is good for bone density and doesn’t cause problems with acidity.

    • Vivian Goldschmidt, MA

      Without a doubt, protein is essential for healthy bones, Jenny. You can still consume plenty of animal protein and balance it with alkalizing side dishes. You can also use protein powder and eat plant-based foods that contain good amounts of protein.

  3. Alistair Powell

    I’m on Prolia. Does this mean that calcium cannot be taken from my bones to alkalise the acidity?

    • Vivian Goldschmidt, MA

      Prolia basically deactivates osteoclasts and does not affect they way your body would react to an acid serum pH.
      You can read more about Prolia here:

      • Chris Jackson

        I shall keep your review on Denosumab in mind. The Romosozumab has taken me from a place of uselessness to hope. My hope is that Prolia will take me compound the improvement and allow me to have corrective treatment and quality of life.

  4. Kathie McCleskey

    I also had the same question as one other writer,with regard to what foods are
    conducive to a appropriate alkali/acid balance. You mentioned the “ORP”. what does that mean? Is it another report or program that I have to buy?

    • Vivian Goldschmidt, MA

      Kathie, the ORP is the short version of the Osteoporosis Reversal Program 🙂

    • Diane Martinson

      Kathie, I don’t see anything called ORP, can you tell me where you saw it, I don’t know what it is either.

  5. Mary

    Are the Save Trainer work-outs meant to be done daily or every other day since they are strength training in nature?

    • Vivian Goldschmidt, MA

      Mary, SaveTrainer offers a large variety of workouts besides strength training, such as posture and flexibility, balance and coordination, yoga, and even meditation and stress relief. So you can basically alternate the different kinds of workouts if you wish to exercise on a daily basis 🙂

  6. Mary Lou

    Please list foods (and an estimate of the amounts) which are good for giving ones body what it needs to maintain a good ph balance.
    Thank you so much!
    I’ve followed save our bones since several years a go when I was in a bad card accident. So far, I think I’m doing pretty well but am always open and looking for ways to improve.

    • Vivian Goldschmidt, MA

      Mary Lou,

      I’m so glad you’ve fully recovered from the car accident!

      In the ORP, foods are listed under the alkalizing and acidifying categories. And as I wrote in the ORP, it’s about the acid/alkaline balance when selecting those foods:

      “As you will read in the next section, the ideal pH balance for bone health is achieved by eating eight out of ten foods from the alkalizing group and therefore, only two from the acidifying group. First of all, I’d like to clarify that the 80/20 balance also works as a percentage. This means that you don’t have to eat 10 foods in every dish or even at every meal. For instance, a 4 to 1 balance can work just the same, because 1 is 20% of 5. A dish consisting of lettuce, tomatoes, carrots and onions with turkey and vinaigrette dressing is an example of a 4 to 1 combination. Because all foods except the turkey are from the alkalizing list, you can “mix and match” the 4 alkalizing foods to suit your taste.”

      I hope this helps!

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