Background/Purpose:

Adenosine regulates bone metabolism. In vitro studies suggest that direct stimulation of the adenosine A2A receptor increases osteoblasts and diminishes osteoclasts, and thus inhibition of these receptors might promote osteoporosis. Caffeine is a regular part of many adult diets and acts in part by engaging adenosine receptors. However, the impact of caffeine consumption on bone metabolism remains incompletely elucidated. Previous population based studies have demonstrated that caffeine may be associated an increased risk of osteoporotic fractures in post-menopausal females. The National Health and Nutrition Examination Survey (NHANES) is an ongoing CDC assessment of the health and nutritional status of adults and children in the United States, with a particular emphasis on diet. In this study, we leveraged NHANES to assess whether caffeine intake is a risk factor for osteoporosis and resultant fractures.

Methods:

We utilized NHANES for the 2013-14 cycle, which included a total of 10,175 subjects. All subjects underwent a 24-hour dietary recall interview to estimate intake of a specified panel of nutrients, caffeine included. Bone mineral density (BMD) was evaluated using Dual Energy X-ray Absorptiometry (DEXA) at the hip and spine. Subjects also answered surveys addressing history of prior fractures and risk factors for osteoporosis. Variables considered for analysis were downloaded from NHANES. Statistical analysis was conducted using STATA 14.2. We examined a subpopulation of patients over the age of 40 (N=3,210) and a further subset of Caucasian females over 50 (N=682). Sampling weights were accounted for unequal probabilities of selection. Univariate and multivariate analysis with logistic regression was used for data analyses. In the multivariate analysis, adjustments were made for age, body mass index, physical activity, prior corticosteroid use, smoking and alcohol.

Results:

Baseline characteristics were similar in the two subpopulations. In the subpopulation of men and women over 40, caffeine intake was found to be associated with vertebral spine fractures in the univariate analysis (p=0.01) and decrease in femoral neck BMD (p=<0.001) and spine fractures (p=<0.001) in the multivariate analysis. In the subpopulation of Caucasian women over 50, there was no significant associations from the univariate analysis, however caffeine intake was associated with both hip fractures (p=0.01) and decreased femoral neck BMD (p=0.05) on the multivariate analysis. Of note, in the subpopulation of Caucasian men over 50, there was no significant association between caffeine intake and decreased BMD or fractures.

Conclusion:

In women over 50, caffeine intake is associated with a small but significant decrease in bone mineral density at the femoral neck and increased risk of hip fractures. Further, in a cohort of men and women over 40, we observed a significant association of caffeine intake with increased vertebral spine fractures and decreased femoral neck BMD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/caffeine-consumption-and-risk-of-osteoporosis-a-cross-sectional-study-of-3-210-patients-from-the-national-health-and-nutrition-examination-survey/