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H. Hallström1, 2,*, A. Wolk3, A. Glynn1, E. Warensjö2, 4, L. Byberg2, K. Michaëlsson2
1Risk and Benefit Assessment Department, National Food Agency, 2Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, 3National Institute of Experimental Medicine, Division of Nutritional Epidemiology, Karolinska Institute, Stockholm, 4Science Department, National Food Agency, Uppsala, Sweden

High consumption of coffee and/or of caffeine has been suggested to contribute to the development of osteoporotic fractures, but previous studies have not reported consistent results.

We used a longitudinal, prospective population-based cohort: the Swedish Mammography Cohort (SMC) and a sub cohort: the Swedish Mammography Cohort Clinical (SMCC). 61 433 women (born 1914-1948) were followed up for 19 years. 5022 of these women participated in the SMCC. Primary outcome measures were incident fractures of any type and hip fractures (identified from registry data). Secondary outcome was osteoporosis diagnosed by dual energy x ray absorptiometry in the SMCC. Diet was assessed by repeated food frequency questionnaires.

During follow-up of the SMC, 14 738 women (24%) experienced a first fracture of any type and among them 3871 (6%) a first hip fracture. Of the 5022 women in the SMCC, 1012 (20%) were diagnosed as osteoporotic. After multivariable adjustment, we found no evidence of higher rate of hip fracture (HR 0.97; 95% CI 0.95-1.00 per 200 ml coffee) or any fracture (HR 0.99; 95% CI 0.98-1.00 per 200 ml coffee) with increasing consumption. Compared to women consuming <1 cup daily, those with an intake of ≥4 cups daily had a HR of 0.88 (95% CI 0.78-1.00) for hip fracture and a HR of 0.96 (95% CI 0.90-1.02) for any type of fracture. Women who consumed ≥4 cups vs. <1 cup per day had, however, 2-4% (p<0.001) lower bone mineral density (BMD) at the proximal femur (△ 0.022 g/cm2; 95% CI 0.021-0.023), at the lumbar spine (△ 0.048 g/cm2; 95% CI 0.047-0.050) and of the total body (△ 0.018 g/cm2; 95% CI 0.017-0.019). The odds ratio of osteoporosis was 1.28 (95% CI 0.88-1.87) with a high compared to a low consumption.

An association between high consumption of coffee/high intake of caffeine and a decrease in BMD has been reported in some earlier epidemiological studies and is biologically plausible according to proposed mechanisms. In conclusion, we found an association between a high consumption of coffee and lower BMD, but this small difference in BMD was not substantiated to an increased risk of fractures or osteoporosis, despite a large study size. Thus, a high coffee consumption does not predispose to higher fracture risk in middle-aged and older women.

Disclosure of Interest,: None Declared

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