This mild condition has not been fully assessed in any longitudinal studies lasting as long as 1 year. The initiating event is a chronic low-calcium and high-phosphorus intake (low Ca:high P ratio) that leads to a chronic elevation of serum PTH. Elevations in PTH stimulate osteoclastic bone resorption and declines in bone mass and density. This condition has only been studied experimentally using human subjects for 28 days, but the chronic increases in PTH and vitamin D hormone suggest that even a lowering of the Ca:Pi ratio below 0.5— in this study to ^0.25—resulted in adverse effects. Longer term studies are needed to determine if bone losses occur under this chronic dietary regimen.
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