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Coffee Consumption in Relation to Osteoporosis and Fractures: Observational Studies in Men and Women
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

During the past decades, the incidence of osteoporotic fractures has increased dramatically in the Western world. Consumption of coffee and intake of caffeine have in some studies been found to be associated with increased risk of osteoporotic fractures, but overall results from previous research are inconsistent. Despite weak evidence, some osteoporosis organisations recommend limiting daily coffee or caffeine intake.

The primary aim of this thesis was to study the association between long-term consumption of coffee and bone mineral density (BMD), incidence of osteoporosis and fractures. A secondary aim was to study the relation between tea consumption and fracture risk.

An increased risk of osteoporotic fractures in individuals who consumed ≥ 4 cups of coffee vs < 1 cup coffee per day was demonstrated in a study of 31,257 Swedish middle-aged and elderly women (a part of the Swedish Mammography Cohort - SMC) when calcium intake was low (< 700 mg/day). However, no higher risks of osteoporosis or fractures were observed in the full SMC with increasing coffee consumption. In the full SMC (n = 61,433) the follow-up was longer and the number of fractures was higher. Similarly, no statistically significant associations between consumption of coffee (≥ 4 cups of coffee vs < 1 cup) and incidence of osteoporotic fractures were observed in the Cohort of Swedish Men (COSM), including 45,339 men. Calcium intake did not modify the results from the investigations performed in the full SMC or COSM.

Nonetheless, a 2 - 4% lower BMD at measured sites was observed in men participating in the PIVUS cohort and in women from a sub-cohort of the SMC who consumed ≥ 4 cups of coffee vs < 1 cup daily. Individuals with high coffee intake and rapid metabolism of caffeine had lower BMD at the femoral neck.

No association between tea consumption and risk of fractures was found in the studies.

In conclusion, the findings presented in this thesis demonstrate that high consumption of coffee may be associated with a modest decrease in BMD. However, there was no evidence of a substantially increased incidence of osteoporosis or fractures typically associated with osteoporosis.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. , 100 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 874
Keyword [en]
Coffee, Tea, Caffeine, Bone mineral density, Osteoporosis, Fractures, Cohort studies
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-196332ISBN: 978-91-554-8615-0 (print)OAI: oai:DiVA.org:uu-196332DiVA: diva2:609884
Public defence
2013-04-26, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Research Council
Available from: 2013-04-05 Created: 2013-03-07 Last updated: 2013-08-30Bibliographically approved
List of papers
1. Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women
Open this publication in new window or tab >>Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women
2006 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 17, no 7, 1055-64 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Keyword
Caffeine, Coffee, Cohort study, Fracture, Tea
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-18937 (URN)10.1007/s00198-006-0109-y (DOI)16758142 (PubMedID)
Available from: 2006-11-24 Created: 2006-11-24 Last updated: 2017-12-08Bibliographically approved
2. Coffee consumption and CYP1A2 genotype in relation to bone mineral density of the proximal femur in elderly men and women: a cohort study
Open this publication in new window or tab >>Coffee consumption and CYP1A2 genotype in relation to bone mineral density of the proximal femur in elderly men and women: a cohort study
Show others...
2010 (English)In: Nutrition & metabolism, ISSN 1743-7075, Vol. 7, 12- p.Article in journal (Refereed) Published
Abstract [en]

ABSTRACT: BACKGROUND: Drinking coffee has been linked to reduced calcium conservation, but it is less clear whether it leads to sustained bone mineral loss and if individual predisposition for caffeine metabolism might be important in this context. Therefore, the relation between consumption of coffee and bone mineral density (BMD) at the proximal femur in men and women was studied, taking into account, for the first time, genotypes for cytochrome P450 1A2 (CYP1A2) associated with metabolism of caffeine. METHODS: Dietary intakes of 359 men and 358 women (aged 72 years), participants of the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS), were assessed by a 7-day food diary. Two years later, BMD for total proximal femur, femoral neck and trochanteric regions of the proximal femur were measured by Dual-energy X-ray absorptiometry (DXA). Genotypes of CYP1A2 were determined. Adjusted means of BMD for each category of coffee consumption were calculated. RESULTS: 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. In high consumers of coffee, those with rapid metabolism of caffeine (C/C genotype) had lower BMD at the femoral neck (p = 0.01) and at the trochanter (p = 0.03) than slow metabolizers (T/T and C/T genotypes). Calcium intake did not modify the relation between coffee and BMD. CONCLUSION: High consumption of coffee seems to contribute to a reduction in BMD of the proximal femur in elderly men, but not in women. BMD was lower in high consumers of coffee with rapid metabolism of caffeine, suggesting that rapid metabolizers of caffeine may constitute a risk group for bone loss induced by coffee.

National Category
Surgery
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-123254 (URN)10.1186/1743-7075-7-12 (DOI)000275964400001 ()20175915 (PubMedID)
Available from: 2010-04-27 Created: 2010-04-27 Last updated: 2013-08-30Bibliographically approved
3. Long-term coffee consumption in relation to fracture risk and bone mineral density in women
Open this publication in new window or tab >>Long-term coffee consumption in relation to fracture risk and bone mineral density in women
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2013 (English)In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 178, no 6, 898-909 p.Article in journal (Refereed) Published
Abstract [en]

High consumption of coffee has been suggested to reduce the risk of some late-onset diseases and death but also to contribute to the development of osteoporotic fractures. Results of previous fracture studies have been inconsistent, and a comprehensive study is needed. The longitudinal population-based Swedish Mammography Cohort, including 61,433 women born in 1914-1948, was followed up from 1987 through 2008. Coffeeconsumption was assessed with repeated food frequency questionnaires. During follow-up, 14,738 women experienced fracture of any type, and 3,871 had a hip fracture. In a subcohort (n = 5,022), bone density was measured and osteoporosis determined (n = 1,012). After multivariable adjustment, there was no evidence of a higher rate of any fracture (hazard ratio per 200 mL coffee = 0.99; 95% confidence interval: 0.98, 1.00) or hip fracture (hazard ratio per 200 mL coffee = 0.97, 95% confidence interval: 0.95, 1.00) with increasing coffeeconsumption. A high coffee intake (>= 4 cups daily) versus a low intake (<1 cup daily) was associated with a 2%-4% lower bone density, depending on site (P < 0.001), but the odds ratio for osteoporosis was only 1.28 (95% confidence interval: 0.88, 1.87). Thus, high coffeeconsumption was associated with a small reduction in bone density that did not translate into an increased risk of fracture.

Keyword
Bone mineral density, coffee, cohort study, fracture, osteoporosis
National Category
Medical and Health Sciences
Research subject
Epidemiology
Identifiers
urn:nbn:se:uu:diva-196322 (URN)10.1093/aje/kwt062 (DOI)000325150600012 ()
Funder
Swedish Research Council
Available from: 2013-03-07 Created: 2013-03-07 Last updated: 2017-12-06Bibliographically approved
4. Coffee Consumption and Risk of Fracture in the Cohort of Swedish Men (COSM)
Open this publication in new window or tab >>Coffee Consumption and Risk of Fracture in the Cohort of Swedish Men (COSM)
Show others...
2014 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 5, e97770- p.Article in journal (Refereed) Published
Abstract [en]

Background: Recent research in a large cohort of women showed that coffee consumption is not associated with increased risk of fracture. Whether this is the case also among men is less clear. Methods: In the Cohort of Swedish Men (COSM) study, 42,978 men aged 45-79 years old at baseline in 1997 answered a self-administered food frequency questionnaire covering coffee consumption and a medical and lifestyle questionnaire covering potential confounders. Our main outcomes first fracture at any site and first hip fracture were collected from the National Patient Registry in Sweden. The association between coffee consumption and fracture risk was investigated using Cox's proportional hazards regression. Results: During a mean follow-up of 11.2 years, 5,066 men had a first fracture at any site and of these, 1,186 (23%) were hip fractures. There was no association between increasing coffee consumption (per 200 ml) and rate of any fracture (hazard ratio [HR] 1.00; 95% confidence interval [CI] 0.99-1.02) or hip fracture (HR 1.02; 95% CI 0.99-1.06) after adjustment for potential confounders. For men consuming >= 4 cups of coffee/day compared to those consuming <1 cup of coffee/day, HR for any type of fracture was 0.91 (95% CI 0.80-1.02) and for hip fracture: 0.89 (95% CI 0.70-1.14). Conclusions: High coffee consumption was not associated with an increased risk of fractures in this large cohort of Swedish men.

Keyword
Coffee, cohort, fracture, men, osteoporosis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:uu:diva-196326 (URN)10.1371/journal.pone.0097770 (DOI)000336789500113 ()
Funder
Swedish Research Council
Available from: 2013-03-07 Created: 2013-03-07 Last updated: 2017-12-06Bibliographically approved

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