Chocolate and chocolate constituents influence bone health and osteoporosis risk

Nutrition. 2019 Sep:65:74-84. doi: 10.1016/j.nut.2019.02.011. Epub 2019 Feb 26.


Bone loss resulting in increased risk for osteoporosis is a major health issue worldwide. Chocolate is a rich source of antioxidant and antiinflammatory flavonoids and dietary minerals with the potential to benefit bone health. However, other chocolate constituents such as cocoa butter, sugar, and methylxanthines may be detrimental to bone. Human studies investigating the role of chocolate consumption on serum bone markers and bone mineral density (BMD) have been inconsistent. A contributing factor is likely the different composition and thereby the nutrient and bioactive content among chocolate types. White and milk chocolate are high in sugar and low in flavonoids and most minerals. Dark chocolate (45-85% cocoa solids) is high in flavonoids, most minerals, and low in sugar with ≥70% cocoa solids resulting in higher fat and methylxanthine content. The aim of this review was to examine the relationship between chocolate consumption and its constiuents, including flavonoid content, on bone health and osteoporosis risk. Studies showed postmenopausal women had no bone effects at moderate chocolate intakes, whereas adolescents consuming chocolate had greater longitudinal bone growth. Based on flavonoid and mineral content, unsweetened cocoa powder appeared to be the best option followed by dark chocolate with higher cocoa content in terms of supporting and preserving bone health. Determining dietary recommendations for chocolate consumption relative to bone health is important because of the growing popularity of chocolate, particularly dark chocolate, and an expected increase in consumption owing to suggestions of health benefits against various degenerative diseases.

Keywords: Bone; Chocolate; Cocoa butter; Dietary minerals; Flavonoids; Methylxanthine; Sugar.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Bone Density*
  • Cacao / chemistry*
  • Chocolate / adverse effects*
  • Diet / adverse effects*
  • Diet / methods
  • Female
  • Flavonoids / adverse effects
  • Humans
  • Male
  • Middle Aged
  • Osteoporosis / etiology*
  • Risk Factors
  • Xanthines / adverse effects
  • Young Adult


  • Flavonoids
  • Xanthines
  • methylxanthine