Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study1,2,3

Katherine L Tucker, Kyoko Morita, Ning Qiao, Marian T Hannan, L Adrienne Cupples and Douglas P Kiel

Background: Soft drink consumption may have adverse effects on bone mineral density (BMD), but studies have shown mixed results. In addition to displacing healthier beverages, colas contain caffeine and phosphoric acid (H3PO4), which may adversely affect bone.

Objective: We hypothesized that consumption of cola is associated with lower BMD.

Design: BMD was measured at the spine and 3 hip sites in 1413 women and 1125 men in the Framingham Osteoporosis Study by using dual-energy X-ray absorptiometry. Dietary intake was assessed by food-frequency questionnaire. We regressed each BMD measure on the frequency of soft drink consumption for men and women after adjustment for body mass index, height, age, energy intake, physical activity score, smoking, alcohol use, total calcium intake, total vitamin D intake, caffeine from noncola sources, season of measurement, and, for women, menopausal status and estrogen use.

Results: Cola intake was associated with significantly lower (P < 0.001