Ossäre Bedeutung von Mineral- und Heilwässern: Physiologie und epidemiologische Evidenz

Zusammenfassung

Mineral- und Heilwässer zeichnen sich durch eine sortenspezifische Zusammensetzung aus, so dass sich die Wässer auch ausernährungsphysiologischer Sicht voneinander unterscheiden. Viele Mineral- und Heilwässer bilden eine quantitativ bedeutsame Quelle für gut bioverfügbares Calcium und Magnesium. Calciumreiche Wässer stellen somit eine günstige Alternative zum gut löslichen Calciumcitrat dar, wie es in der Leitlinie der Bone Health & Osteoporosis Foundation bei Achlorhydrie oder eingeschränkter Magensäureproduktion (z. B. Therapie mit Protonenpumpeninhibitoren) als Calciumquelle empfohlen wird. Calciumwässer senken den Serumspiegel an Parathormon ähnlich stark wie Calcium aus Milch oder Supplementen mit einem äquivalenten Gehalt des Mineralstoffs. Damit verbunden ist bei alkalischen Calciumwässern eine Hemmung der Knochenresorption. Auch senken bikarbonatreiche Wässer die renale Säurelast sowie die Calciumverluste über den Urin. Ungeklärt ist der Einfluss der Wässer auf die Calciumbilanz und das Frakturrisiko. Der Natrium- und Kaliumgehalt der meisten Wässer ist zu gering, um den Knochenstoffwechsel nennenswert beeinflussen zu können. Auch üben Wässer mit moderatem Fluoridgehalt (0,70-1,0 mg/l) keinen, von anderen Nahrungsfaktoren (Calcium, Protein) unabhängigen Einfluss auf die Mikrostruktur der Knochen aus.

Abstract

Mineral waters and medicinal waters are characterised by their specific composition, which makes them different from a nutritional point of view. Many mineral and medicinal waters are a quantitatively significant source of readily bioavailable calcium and magnesium. Calcium-rich waters are therefore a favourable alternative to readily soluble calcium citrate, which is recommended by the guideline of the Bone Health & Osteoporosis Foundation as a source of calcium in cases of achlorhydria or restricted gastric acid production (e. g. therapy with proton pump inhibitors). Calcium waters lower serum parathyroid hormone similarly to calcium from milk or supplements with equivalent mineral content. Moreover, alkaline calcium waters inhibit bone resorption. Bicarbonate-rich waters also reduce renal acid load and, as a result, urinary calcium losses. However, the waters effect on calcium balance and fracture risk is unclear. Besides, the sodium and potassium content of most waters is too low to have a significant effect on bone metabolism. Even waters with a moderate fluoride content (0.70–1.0 mg/l) have no effect on bone microstructure, independent of other dietary factors (calcium, protein).

Schlüsselwörter

Calcium - Mineralwasser - Bikarbonat - Knochenstoffwechsel - Säurelast

Key words

calcium - mineral water - bicarbonate - net acid load - bone metabolism

Publikationsverlauf

Eingereicht: 29. Juni 2023

Angenommen: 07. September 2023

Artikel online veröffentlicht:
06. Oktober 2023

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