Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group.
Many risk factors for hip fractures have been suggested but have not been evaluated in a comprehensive prospective study.
We assessed potential risk factors, including bone mass, in 9516 white women 65 years of age or older who had had no previous hip fracture. We then followed these women at 4-month intervals for an average of 4.1 years to determine the frequency of hip fracture. All reports of hip fractures were validated by review of x-ray films.
During the follow-up period, 192 women had first hip fractures not due to motor vehicle accidents. In multivariable age-adjusted analyses, a maternal history of hip fracture doubled the risk of hip fracture (relative risk, 2.0; 95 percent confidence interval, 1.4 to 2.9), and the increase in risk remained significant after adjustment for bone density. Women who had gained weight since the age of 25 had a lower risk. The risk was higher among women who had previous fractures of any type after the age of 50, were tall at the age of 25, rated their own health as fair or poor, had previous hyperthyroidism, had been treated with long-acting benzodiazepines or anticonvulsant drugs, ingested greater amounts of caffeine, or spent four hours a day or less on their feet. Examination findings associated with an increased risk included the inability to rise from a chair without using one’s arms, poor depth perception, poor contrast sensitivity, and tachycardia at rest. Low calcaneal bone density was also an independent risk factor. The incidence of hip fracture ranged from 1.1 (95 percent confidence interval, 0.5 to 1.6) per 1,000 woman-years among women with no more than two risk factors and normal calcaneal bone density for their age to 27 (95 percent confidence interval, 20 to 34) per 1,000 woman-years among those with five or more risk factors and bone density in the lowest third for their age.
Women with multiple risk factors and low bone density have an especially high risk of hip fracture. Maintaining body weight, walking for exercise, avoiding long-acting benzodiazepines, minimizing caffeine intake, and treating impaired visual function are among the steps that may decrease the risk.
Cummings SR, Nevitt MC, Browner WS, Stone K…
N. Engl. J. Med. Mar 1995
PMID: 7862179 | Free Full Text
Coffee consumption and bone mineral density in korean premenopausal women.
Although Asian people are known to have lower bone mass than that of Caucasians, little is known about coffee-associated bone health in Asian. This study aimed to assess the relationship between coffee consumption and bone mineral density (BMD) in Korean premenopausal women.
Data were obtained from the Fourth Korea National Health and Nutrition Examination Survey 2008-2009. The study population consisted of 1,761 Korean premenopausal women (mean age 36 years) who were measured for lumbar spine and femoral neck BMD and who completed a standardized questionnaire about coffee intake frequency. We excluded the participants who took hormone replacement therapy or medication for osteoporosis. The cross-sectional relationship between coffee consumption and impaired bone health (osteopenia or osteoporosis) was investigated by bone densitometry.
Coffee consumption showed no significant association with BMD of either femoral neck or lumbar spine, independent of other factors. The adjusted odds ratios for BMD for those who consumed once in a day, twice a day and three times a day were 0.94 (0.70-1.26), 0.93 (0.67-1.28), and 1.02 (0.69-1.50), respectively (P for trend = 0.927).
This study does not support the idea that coffee is a risk factor for impaired bone health in Korean premenopausal women.
Choi EJ, Kim KH, Koh YJ, Lee JS…
Korean J Fam Med Jan 2014
PMID: 24501665 | Free Full Text
This study shows that high consumption of coffee is not associated with increased risk for impaired bone health. Our results are in agreement with some recent cross-sectional studies showing no association between caffeine and impaired bone health, and in disagreement with others which focused on BMD of various skeletal sites.22-26) Habitual dietary caffeine intake was found not to be associated with impaired bone health in healthy postmenopausal women in a longitudinal study in Pennsylvania (USA), on the basis of self-reported questionnaires collected in 2000.23) In elderly men and women from the population-based Framingham Osteoporosis Study, the same results were found.24) These studies are in agreement with our study. Although the frequency consumed and the species of coffee could be significantly affected by cultural differences and socioeconomic status, and the metabolism of caffeine and other constituents can be affected by genetic predisposition, our results in Korean premenopausal women did not appear to contradict those of previous studies.
The role of coffee intake in bone health, however, seems controversial. There are several studies showing a negative association between caffeine and bone health. Daily intake of 330 mg of caffeine, equivalent to 4 cups (600 mL) of coffee, or more may be associated with a modestly increased risk of osteoporotic fractures, especially in women with a low intake of calcium, as shown in a study on Swedish women aged 40 to 76 years.4) Also, in a cohort study, Men consuming 4 cups of coffee or more per day had 4% lower BMD at the proximal femur (P = 0.04) compared with low or non-consumers of coffee. This difference was not observed in women, suggesting that rapid metabolizers of caffeine may constitute a risk group for bone loss induced by coffee.24)
Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women.
Consumption of coffee and tea, and total intake of caffeine has been claimed to be associated with osteoporotic fracture risk. However, results of earlier studies lack consistency.
We examined this relation in a cohort of 31,527 Swedish women aged 40-76 years at baseline in 1988. The consumption of coffee, caffeinated tea and the intake of caffeine were estimated from a self-administered food frequency questionnaire (FFQ). Multivariate-adjusted hazards ratios (HRs) of fractures with 95% confidence intervals (95% CIs) were estimated by Cox proportional hazards models.
During a mean follow-up of 10.3 years, we observed 3,279 cases with osteoporotic fractures. The highest (>330 mg/day) compared with the lowest (<200 mg/day) quintile of caffeine intake was associated with a modestly increased risk of fracture: HR 1.20 (95% CI: 1.07-1.35). A high coffee consumption significantly increased the risk of fracture (p for trend 0.002), whereas tea drinking was not associated with risk. The increased risk of fracture with both a high caffeine intake and coffee consumption was confined to women with a low calcium intake (<700 mg/day): HR 1.33 (95% CI: 1.07-1.65) with > or =4 cups (600 ml)/day of coffee compared to <1 cup (150 ml)/day. The same comparison but risk estimated for women with a high propensity for fractures (> or =2 fracture types) revealed a HR of 1.88 (95% CI: 1.17-3.00).
In conclusion, our results indicate that a daily intake of 330 mg of caffeine, equivalent to 4 cups (600 ml) of coffee, or more may be associated with a modestly increased risk of osteoporotic fractures, especially in women with a low intake of calcium.
Hallström H, Wolk A, Glynn A, Michaëlsson K
Osteoporos Int 2006
Favorable effect of moderate dose caffeine on the skeletal system in ovariectomized rats.
Caffeine, a methylxanthine present in coffee, has been postulated to be responsible for an increased risk of osteoporosis in coffee drinkers; however, the data are inconsistent. The aim of the present study was to investigate the effects of a moderate dose of caffeine on the skeletal system of rats with normal and decreased estrogen level (developing osteoporosis due to estrogen deficiency).
The experiments were carried out on mature nonovariectomized and ovariectomized Wistar rats, divided into control rats and rats receiving caffeine once daily, 20 mg/kg p.o., for 4 wk. Serum bone turnover markers, bone mass, mass of bone mineral, calcium and phosphorus content, histomorphometric parameters, and bone mechanical properties were examined. Caffeine favorably affected the skeletal system of ovariectomized rats, slightly inhibiting the development of bone changes induced by estrogen deficiency (increasing bone mineralization, and improving the strength and structure of cancellous bone). Moreover, it favorably affected mechanical properties of compact bone. There were no significant effects of caffeine in rats with normal estrogen levels.
In conclusion, results of the present study indicate that low-to-moderate caffeine intake may exert some beneficial effects on the skeletal system of mature organisms.
Folwarczna J, Pytlik M, Zych M, Cegieła U…
Mol Nutr Food Res Oct 2013
To drink or not to drink: how are alcohol, caffeine and past smoking related to bone mineral density in elderly women?
To determine relationship between alcohol, caffeine, past smoking and bone mineral density of different skeletal sites in elderly women, accounting for other biological and life-style variables.
A cross-sectional study in 136 Caucasian women, mean +/- SD age 68.6 +/- 7.1 years, all healthy and free of medications affecting bones, including estrogen. Bone mineral density (BMD) of multiple skeletal regions and body composition were measured by dual X-ray absorptiometry. Serum vitamin D (25-OHD) and parathyroid hormone (PTH) were analyzed and used as confounders. Calcium (Ca) intake was assessed by food frequency questionnaire. Alcohol and caffeine consumption was assessed by questionnaires determining frequency, amount and source of each. There were no current smokers, but the history of smoking was recorded, including number of years and packages smoked/day. Past physical activity was assessed by Allied Dunbar National Fitness Survey and used as confounder. Statistical significance was considered at p <or= 0.05.
In the correlational analysis, alcohol was positively associated with spine BMD (r = 0.197, p = 0.02), 25-OHD and negatively with PTH. Smoking was negatively related to Ca intake, 25(OH)D and number of reproductive years. In subgroup (stratified by Ca intake) and multiple regression analyses, alcohol (average approximately 0.5-1 drinks/day or approximately 8 g alcohol/day) was favorably associated with BMD of spine and total body. Caffeine (average approximately 2.5 6-fl oz cups/day or 200-300 mg caffeine/day) had negative association with most of the skeletal sites, which was attenuated with higher Ca intake (>or=median, 750 mg/day). The past smokers who smoked on average 24 years of approximately 1 pack cigarettes/day had lower BMD in total body, spine and femur than never-smokers when evaluated in subgroup analyses, and the association was attenuated in participants with >or=median Ca intake. There was no significant association between past smoking and BMD of any skeletal site in multiple regression analyses.
The results support the notion that consumption of small/moderate amount of alcohol is positively, while caffeine and past smoking are negatively associated with most of the skeletal sites, which might be attenuated with Ca intake above 750 mg/day.
Ilich JZ, Brownbill RA, Tamborini L, Crncevic-Orlic Z
J Am Coll Nutr Dec 2002
It is interesting how many things are bad when calcium is low. There is some evidence that high protein, caffeine, and sodium are all bad for bones only when calcium is low. Otherwise, they all may be moderately good for bones when calcium is high.
Effects of caffeine on bone and the calcium economy.
Caffeine-containing beverage consumption has been reported to be associated with reduced bone mass and increased fracture risk in some, but not most, observational studies. Human physiological studies and controlled balance studies show a clear but only a very small depressant effect of caffeine itself on intestinal calcium absorption, and no effect on total 24-h urinary calcium excretion. The epidemiologic studies showing a negative effect may be explained in part by an inverse relationship between consumption of milk and caffeine-containing beverages. Low calcium intake is clearly linked to skeletal fragility, and it is likely that a high caffeine intake is often a marker for a low calcium intake. The negative effect of caffeine on calcium absorption is small enough to be fully offset by as little as 1-2 tablespoons of milk. All of the observations implicating caffeine-containing beverages as a risk factor for osteoporosis have been made in populations consuming substantially less than optimal calcium intakes. There is no evidence that caffeine has any harmful effect on bone status or on the calcium economy in individuals who ingest the currently recommended daily allowances of calcium.
Food Chem. Toxicol. Sep 2002
Dietary caffeine intake and bone status of postmenopausal women.
Dietary caffeine intake has been suggested as a risk factor for bone loss in postmenopausal women. We measured the bone density of both hips and the total body in 138 healthy, postmenopausal women aged 55-70 y who had either never used hormone replacement therapy (HRT) or had used HRT for < 1 y. In this cross-sectional study, participants were stratified according to their reported current and long-time caffeinated beverage use into one of three groups: low [0-2 cups (180 mL, or 6 oz per cup) caffeinated coffee per day], moderate (3-4 cups caffeinated coffee per day), or high (> or = 5 cups caffeinated coffee per day). Caffeine intake was measured from diet records and by gas chromatography of each subject’s brewed, caffeinated beverages. No association between caffeine intake and any bone measurement was observed. The anthropometric and nutrient intakes of the three groups were similar. Compared with caffeine intake based on chemical analysis of brewed beverages, 3-d prospective food records and computer-assisted analysis overestimated caffeine intake by nearly two-thirds. In conclusion, the habitual dietary caffeine intake of this cohort of 138 postmenopausal women ranged from 0-1400 mg/d and was not associated with total body or hip bone mineral density measurements. This study does not support the notion that caffeine is a risk factor for bone loss in healthy postmenopausal women.
Lloyd T, Rollings N, Eggli DF, Kieselhorst K…
Am. J. Clin. Nutr. Jun 1997
PMID: 9174479 | Free Full Text
Caffeine and bone loss in healthy postmenopausal women.
The effects of caffeine consumption on rates of change in bone mineral density (BMD) were examined in 205 healthy, nonsmoking, postmenopausal women. BMD of the spine and total body were measured by dual-energy x-ray absorptiometry, and dietary intakes by food-frequency questionnaire. Among women with calcium intakes above the median (744 mg/d), 1-y rates of bone change–adjusted for years since menopause, body mass index, physical activity, and baseline BMD–did not differ by caffeine intake. However, among women consuming less calcium, those with the highest caffeine intakes (> 450 mg/d) had significantly more bone loss (ANCOVA, P < 0.05) than did women consuming less caffeine (0-171 and 182-419 mg/d). Percent change in BMD by lowest to highest tertile of caffeine consumption was 0.26 +/- 2.74, 0.70 +/- 2.70, and -1.36 +/- 2.70 at the spine and -0.19 +/- 1.24, 0.23 +/- 1.23, and -0.68 +/- 1.25 at the total body. Daily consumption of caffeine in amounts equal to or greater than that obtained from about two to three servings of brewed coffee may accelerate bone loss from the spine and total body in women with calcium intakes below the recommended dietary allowance of 800 mg.
Harris SS, Dawson-Hughes B
Am. J. Clin. Nutr. Oct 1994
PMID: 8092093 | Free Full Text
Caffeine and the risk of hip fracture: the Framingham Study.
Caffeine increases urinary calcium output and has been implicated as a risk factor for osteoporosis. The authors examined the effect of caffeine on hip fracture risk in 3,170 individuals attending the 12th (1971-1973) Framingham Study examination. Coffee and tea consumption, age, Framingham examination number, weight, smoking, alcohol consumption, and estrogen use were used to evaluate hip fracture risk according to caffeine intake. Hip fractures occurred in 135 subjects during 12 years of follow-up. Fracture risk over each 2-year period increased with increasing caffeine intake (one cup of coffee = one unit of caffeine, one cup of tea = 1/2 unit of caffeine). For intake of 1.5-2.0 units per day, the adjusted relative risk (RR) of fracture was not significantly elevated compared with intake of one or less units per day. Consumption of greater than or equal to 2.5 units per day significantly increased the risk of fracture. Overall, intake of greater than two cups of coffee per day (four cups of tea) increased the risk of fracture. In summary, hip fracture risk was modestly increased with heavy caffeine use, but not for intake equivalent to one cup of coffee per day. Since caffeine use may be associated with other behaviors that are, themselves, risk factors for fracture, the association may be indirect. Further studies should be performed to confirm these findings.
Kiel DP, Felson DT, Hannan MT, Anderson JJ…
Am. J. Epidemiol. Oct 1990
Is caffeine associated with bone mineral density in young adult women?
By increasing the urinary excretion of calcium, caffeine consumption may reduce bone mineral density (BMD) and subsequently increase the risk for osteoporotic fracture. Although negative associations between caffeine consumption and BMD have been reported for postmenopausal women, in particular for those who consume low amounts of dietary calcium, the relation between caffeine and BMD in younger women is unclear. Therefore, we evaluated the association between caffeine consumption and BMD in a cross-sectional study of 177 healthy white women, age 19-26 years, who attended a Midwestern university.
Average caffeine intake (milligrams per day) was calculated from self-reports of the consumption of coffee, decaffeinated coffee, tea, colas, chocolate products, and select medications during the previous 12 months (mean caffeine intake = 99. 9 mg/day). BMD (grams per square centimeter) at the femoral neck and the lumbar spine was measured by dual-energy X-ray absorptiometry.
After adjusting in linear regression models for potential confounders, including height, body mass index, age at menarche, calcium intake, protein consumption, alcohol consumption, and tobacco use, caffeine consumption was not a significant predictor of BMD. For every 100 mg of caffeine consumed, femoral neck BMD decreased 0.0069 g/cm(2) (95% confidence in terval [CI] = -0.0215, 0. 0076) and lumbar spine BMD decreased 0.0119 g/cm(2) (95% CI = -0. 0271, 0.0033). No single source of caffeine was significantly associated with a decrease in BMD. Furthermore, the association between caffeine consumption and BMD at either site did not differ significantly between those who consumed low levels of calcium (< or =836 mg/day) and those who consumed high levels of calcium (>836 mg/day).
Caffeine intake in the range consumed by young adult women is not an important risk factor for low BMD.
Conlisk AJ, Galuska DA
Prev Med Nov 2000