Which of the following is NOT a complication associated with long-term ketosis?

Long-term ketosis can lead to several complications as the body adjusts to using fat as its primary source of energy instead of carbohydrates. Among the options provided, muscle ache is not considered a direct complication associated with long-term ketosis.

Halitosis, or bad breath, is a common issue in individuals following a ketogenic diet due to the production of acetone, a type of ketone that is released in breath. Dehydration can occur because ketosis causes a shift in fluid balance, often leading to increased urination and loss of electrolytes. Osteoporosis may also be a concern, particularly with some ketogenic diets that may not provide adequate nutrients necessary for bone health.

In contrast to these complications, muscle ache is not typically associated with ketosis per se. While individuals may experience temporary discomfort as they adapt to a ketogenic diet, it is not a long-term complication of sustained ketosis. Instead, factors like exercise and hydration play a more significant role in muscle health. Thus, muscle ache does not fit within the typical complications seen in those maintaining a long-term ketogenic state.