Soft Drink Consumption Linked to Osteoporotic Fractures in Postmenopausal Women

Written by Joyce Smith, BS. Prospective study finds that high soda consumption of at least 14 soda drinks per week is potentially associated with hip fractures in postmenopausal women.  

More than 8.9 million hip fractures resulting from osteoporosis and reduced bone mineral density (BMD) occur per year, which translates into a fracture every 3 seconds ¹ and a predicted increase of 2.6 million by year 2025 ². In elderly populations, 40% of people who suffer hip fractures can no longer walk independently while 60% require assistance with at least one essential activity of daily living ³, contributing to an overall one-year mortality of 21.2% in an elderly population ⁴.  While soft drink consumption has decreased in the US, the country still ranks second highest in the world ⁵.  Even in children and young adults, studies have shown that increased consumption is associated with decreased BMD and increased rates of bone fractures  ⁶; however, inconsistencies ⁷  in study results have suggested that not all soft drinks, only colas, contribute to lower BMD levels and increased bone fracture risk ⁸.

Kremer et al ⁹ collected data on soft drink consumption via self-reported questionnaires from on 72,342 postmenopausal women in the Women’s Health Initiative Observational Study. Median follow-up was more than 11.9 years. The team used multiple linear regression models to establish cross-sectional associations between soft drink intake and hip and lumbar spine BMD, and Cox proportional hazards regression models to determine a potential relationship between soft drink intake and incident hip fractures.

Of the 72,342 women, 3.5 % sustained a total of 2,578 hip fractures.

• Compared to women who never drank soda, those who drank an average of more than fourteen 12-oz servings per week of soda were significantly (26%) more likely to sustain a hip fracture during the study period.
• Women who drank more than 14 servings per week of caffeine-free soda were also significantly (32%) more likely to experience hip fractures.
• No significant risks were evident at low or less than 14 servings per week, suggesting a threshold effect rather than a dose-response relationship.

The highest soda consumption category had a higher proportion of women who reported using hormone therapy and who had a history of oral contraceptive use. They were also more likely to smoke, but less likely to consume alcohol or coffee. Fewer women in this category reported a maternal history of hip fracture, while a higher proportion reported a history of two or more falls. Results did not differ for caffeinated and caffeine free soda drinkers in this category. In addition, BMDs among women in the highest soda consumption category and the category of nondrinkers did not differ significantly, which does not align with the existing hypothesis that cola beverages containing phosphoric acid and caffeine reduce BMD ⁸.

A study limitation was the self-reported soda consumption early in the follow-up period. Future research should quantify risks of soda consumption over adulthood and separated diet soda from sugar-containing soda consumption, colas with non-colas and carbonated from noncarbonated beverages. More research is also needed to identify the biological mechanisms that might be involved in these study results.

Source: Kremer, Pedro A., Gail A. Laughlin, Aladdin H. Shadyab, Carolyn J. Crandall, Kamal Masaki, Tonya Orchard, and Andrea Z. LaCroix. “Association between soft drink consumption and osteoporotic fractures among postmenopausal women: the Women’s Health Initiative.” Menopause 26, no. 11 (2019): 1234-1241.

© 2019 by The North American Menopause Society

Posted March 10, 2020.

Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.

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