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, 112, 51-57

Coffee and Tea Drinking in Relation to Risk of Hip Fracture in the Singapore Chinese Health Study


Coffee and Tea Drinking in Relation to Risk of Hip Fracture in the Singapore Chinese Health Study

Zhaoli Dai et al. Bone.


Meta-analyses of studies conducted among Western populations suggest that coffee consumption does not affect osteoporotic fracture risk. However, experimental studies have shown that the effect of caffeine on bone health may depend on dosage. We examined the associations between consumption of coffee, tea and caffeine and risk of hip fracture in an Asian cohort. In a population-based prospective cohort of 63,257 Chinese men and women aged 45-74 years in Singapore, a validated semi-quantitative food frequency questionnaire was used to assess habitual consumption of coffee and tea at baseline. Cox proportional hazards regression models were used to estimate hazard ratio (HR) and 95% confidence interval (CI) for risk of hip fracture with adjustment for potential confounders. During a mean follow-up of 16.7 years, 2502 incident hip fracture cases were identified. Compared to coffee drinkers <1 cup/week, those who drank ≥4 cups/day had a statistically significant higher risk to develop hip fractures, the HR (95% CI) was 1.32 (1.07, 1.63) in the whole cohort analysis, 1.46 (1.01, 2.10) for men and 1.33 (1.02, 1.72) for women. Among postmenopausal women, compared to those who drank coffee <1 cup/week, drinking 2-3 cups/day was associated with the lowest risk [HR: 0.88 (0.76, 1.01)] and drinking ≥4 cups/day was associated with the highest risk [HR: 1.31 (1.00, 1.71)]. Similar associations with caffeine intake were found among postmenopausal women. Restricted spline analyses suggested a non-linear association between coffee/caffeine consumption and hip fracture risk in postmenopausal women (p for non-linearity ≤ 0.05). No association was found with tea consumption in either sex. These data suggest that drinking coffee ≥4 cups/day is associated with a higher hip fracture risk, while a moderate intake may alleviate risk in postmenopausal women. Future studies should corroborate these results to determine levels of optimal coffee consumption in relation to bone health.

Keywords: Caffeine; Chinese; Coffee; Hip fracture; Tea.

Conflict of interest statement

Disclosure: All authors state that they have no conflict of interest. W-P Koh is supported by the National Medical Research Council, Singapore (NMRC/CSA/0055/2013).


Figure 1
Figure 1
Association between daily coffee or caffeine intake and risk of hip fracture among postmenopausal women using restricted cubic spline regression (n=25,522) Hazard ratios and 95% confidence intervals were adjusted for age at recruitment (years), year of recruitment (1993–1995, 1995–1998), dialect group (Hokkien, Cantonese), and level of education in categories (no formal education, primary school, secondary school or higher), body mass index (kg/m2), smoking status (never smokers, ex-smokers, and current smokers), moderate physical activity (none, 0.5 – <4 hours weekly, ≥4 hours weekly), at least weekly use of vitamins/mineral (yes, no), use of hormone replacement therapy at recruitment (postmenopausal women only; yes, no), total energy intake (kcal), calcium (mg/1,000kcal/day in quartiles), fruit-vegetable-soy dietary pattern (in quintiles), and caffeinated tea drinking frequency (for the association of coffee only; <weekly, weekly, daily drinkers), and baseline physician-diagnosed history of diabetes (yes, no) and stroke (yes, no).

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