Dietary protein and bone health Anssi Manninen, Advanced Research Press, Inc. 8 September 2006 A well-written review Valsamis et al. discussed the pathophysiologic mechanisms of bone disease associated with anti-epileptic use. The authors righly pointed out that low calcium intake and vitamin D deficiency can aggravate adverse bone effects. However, the importance of adequate dietary protein went unrecognized. Like calcium and vitamin D, protein is an critical nutrient for bone health. The old hypothesis that proteins (especially animal proteins) are causally associated with an increased incidence of osteoporotic fractures is simply incorrect . In fact, prospective epidemiologic observations indicate that higher protein intake is associated with increased bone mineral mass and reduced incidence of osteoporotic fractures . In addition, higher protein intake has positive effects on skeletal muscle [2,3], and in turn the maintenance of adequate bone density is highly dependent on the maintenance of adequate muscle mass and function . Anssi H. ManninenReferences1. Bonjour JP. Dietary protein: an essential nutrient for bone health. J Am Coll Nutr. 2005;24:526S-36S.2. Manninen AH. Hyperinsulinemia, hyperaminoacidemia and post-exercise muscle anabolism: the search for the optimal recovery drink. Br J Sports Med. 2006 Sep 1; [Epub ahead of print].3. Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr 2006 84: 475-482. Competing interests None.