Energy metabolism and ketogenic diets: What about the skeletal health? a narrative review and a prospective vision for planning clinical trials on this issue

Daniela Merlotti, Roberta Cosso, Cristina Eller-Vainicher, Fabio Vescini, Iacopo Chiodini, Luigi Gennari, Alberto Falchetti

Research output: Contribution to journalReview articlepeer-review

Abstract

The existence of a common mesenchymal cell progenitor shared by bone, skeletal muscle, and adipocytes cell progenitors, makes the role of the skeleton in energy metabolism no longer surprising. Thus, bone fragility could also be seen as a consequence of a “poor” quality in nutrition. Ketogenic diet was originally proven to be effective in epilepsy, and long-term follow-up studies on epileptic children undergoing a ketogenic diet reported an increased incidence of bone fractures and decreased bone mineral density. However, the causes of such negative impacts on bone health have to be better defined. In these subjects, the concomitant use of antiepileptic drugs and the reduced mobilization may partly explain the negative effects on bone health, but little is known about the effects of diet itself, and/or generic alterations in vitamin D and/or impaired growth factor production. Despite these remarks, clinical studies were adequately designed to investigate bone health are scarce and bone health related aspects are not included among the various metabolic pathologies positively influenced by ketogenic diets. Here, we provide not only a narrative review on this issue, but also practical advice to design and implement clinical studies on ketogenic nutritional regimens and bone health outcomes. Perspectives on ketogenic regimens, microbiota, microRNAs, and bone health are also included.

Original languageEnglish
Article number435
Number of pages33
JournalInternational Journal of Molecular Sciences
Volume22
Issue number1
DOIs
Publication statusPublished - Jan 1 2021

Keywords

  • Bone health
  • Bone mass
  • Bone turnover markers
  • DXA scans
  • Energy metabolism
  • Fragility fractures
  • Ketogenic diets
  • Ketone bodies

ASJC Scopus subject areas

  • Catalysis
  • Molecular Biology
  • Spectroscopy
  • Computer Science Applications
  • Physical and Theoretical Chemistry
  • Organic Chemistry
  • Inorganic Chemistry

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