This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Skeletal buffering of chronic acid loads may contribute to a significant amount of bone loss over time. Evidence from a few small short-term studies suggests that basic compounds, namely potassium citrate and potassium bicarbonate may reduce bone loss and improve bone density. The purpose of this study is to evaluate the effects of potassium citrate on bone metabolism. We hypothesize that administration of potassium citrate to postmenopausal women with osteopenia will increase bone formation, reduce bone resorption, and improve bone mineral density. Postmenopausal women with osteopenia (T score between 1.0 and 2.5) and no history of fracture will be randomized to either potassium citrate 40 mEq daily or placebo for one year. Primary outcomes will be markers of bone turnover, N-telopeptide, bone specific alkaline phosphatase and osteocalcin, which will be measured at baseline, 1,3, 6 and 12 months. Secondary outcomes will be bone mineral density, measured at the lumbar spine and total hip at baseline and 12 months, compliance, and adverse events, assessed every three months. Levels of urinary citrate and sulfate will also be measured at baseline and 12 months to evaluate subjects differential amounts of acid excretion, and a secondary analysis will be performed to assess whether subjects with high sulfate or low citrate ( markers of increased urinary acid excretion) will have improved treatment responses compared to subjects with normal urinary parameters.
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