Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-23T08:02:38.175Z Has data issue: false hasContentIssue false

Association of fractures with caffeine and alcohol in postmenopausal women: the Iowa Women's Health Study

Published online by Cambridge University Press:  02 January 2007

Solveig A Hansen
Affiliation:
Division of Epidemiology, School of Public Health, Suite 300, University of Minnesota, 1300 South Second Street, Minneapolis, MN 55454–1015, USA
Aaron R Folsom*
Affiliation:
Division of Epidemiology, School of Public Health, Suite 300, University of Minnesota, 1300 South Second Street, Minneapolis, MN 55454–1015, USA
Lawrence H Kushi
Affiliation:
Division of Epidemiology, School of Public Health, Suite 300, University of Minnesota, 1300 South Second Street, Minneapolis, MN 55454–1015, USA
Thomas A Sellers
Affiliation:
Mayo Foundation, 200 First Street SW, Rochester, MN 55905, USA
*
*Corresponding author: Email folsom@epi.umn.edu
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective

To assess whether alcoholic and caffeinated beverages are associated with risk of fractures in women.

Setting

Population-based sample surveyed by post.

Subjects

A total of 34703 postmenopausal Iowan women aged 55–69 years were surveyed.

Design

A cohort of women reported alcoholic and caffeinated beverage intake and were followed for 6.5 years for fracture occurrence. Relative risks (RR) and 95% confidence intervals (CI) were computed using Cox proportional hazards regression. Covariates included age, tobacco use, physical activity, body mass index (BMI), waist to hip ratio (WHR), oestrogen use and calcium intake.

Results

At least one fracture was reported by 4378 women (389 upper arm, 288 forearm, 1128 wrist, 275 hip, 416 vertebral and 2920 other fractures). The adjusted RR for highest versus lowest caffeine intake quintiles was 1.09 (95% CI 0.99–1.21) for combined fracture sites. Wrist fractures were associated positively (RR for extreme quintiles 1.37, 95% CI 1.11–1.69) and upper arm fractures were negatively associated (RR 0.67, 95% CI 0.48–0.94) with caffeine intake. The age-adjusted RR of total fractures for highest versus lowest frequency of beer usage was 1.55 (95% CI 1.25–1.92) and for liquor was 1.25 (95% CI 1.03–1.54). No other association was found between any specific fracture site and alcohol intake.

Conclusions

We found a modest increase in fracture risk associated with highest caffeine intake, varying by site. Alcohol intake was low, but it also showed a weak positive association with fracture risk.

Type
Research Article
Copyright
Copyright © CABI Publishing 2000

References

1Riggs, BL, Melton, LJ III. The prevention and treatment of osteoporosis. N. Engl. J. Med. 1992; 327: 620–7.Google ScholarPubMed
2Barone, JJ, Roberts, H. Human consumption of caffeine. In: Dews, PB, ed. Caffeine. Berlin: Springer-Verlag, 1984; 5973.CrossRefGoogle Scholar
3Graham, DM. Caffeine – its identity, dietary sources, intake and biological effects. Nutr. Rev. 1978; 36: 97102.CrossRefGoogle ScholarPubMed
4Elmazar, MMA, McElhatton, PR, Sullivan, FM. Studies on the teratogenic effects of different oral preparations of caffeine in mice. Toxicology 1982; 23: 5771.CrossRefGoogle ScholarPubMed
5Nakamoto, T, Shaye, R.Effects of caffeine on the growth of mandible and long bone in protein-energy malnourished newborn rats. Proc. Soc. Exp. Biol. Med. 1984; 177: 5561.CrossRefGoogle ScholarPubMed
6Glajchen, N, Ismail, F, Epstein, S, Jowell, PS, Fallon, M.The effect of chronic caffeine administration on serum markers of bone mineral metabolism and bone histo-morphometry in the rat. Calcif. Tissue Int. 1980; 43: 277–80.CrossRefGoogle Scholar
7Bergman, EA, Newbrey, JW, Massey, LK. Caffeine does not cause in vitro calcium loss from neonatal mouse calvaria. Calcif. Tissue Int. 1988; 43: 281–3.CrossRefGoogle Scholar
8Yeh, JK, Aloia, JF. Differential effect of caffeine administration on calcium and vitamin D metabolism in young and adult rats. J. Bone Miner. Res. 1986; 1: 251–8.CrossRefGoogle ScholarPubMed
9Whiting, SJ, Whitney, HL. Effect of dietary caffeine and theophylline on urinary calcium excretion in the adult rat. J. Nutr. 1987; 117: 1224–8.CrossRefGoogle ScholarPubMed
10Heaney, RP, Recker, RR. Effects of nitrogen, phosphorus and caffeine on calcium balance in women. J. Lab. Clin. Med. 1982; 99: 4655.Google ScholarPubMed
11Bergman, EA, Massey, LK, Wise, KJ, Sherrard, DJ. Effects of dietary caffeine on renal handling of minerals in adult women. Life Sci. 1990; 47: 557–64.CrossRefGoogle ScholarPubMed
12Massey, LK, Wise, KJ. The effect of dietary caffeine on urinary excretion of calcium, magnesium, sodium and potassium in healthy young females. Nutr. Res. 1984; 4: 4350.CrossRefGoogle Scholar
13Massey, LK, Berg, TA. The effects of dietary caffeine on urinary excretion of calcium, magnesium, phosphorus, sodium, potassium chloride and zinc in healthy males. Nutr. Res. 1985; 5: 1281–4.CrossRefGoogle Scholar
14Massey, LK, Hollingbery, PW. Acute effects of dietary caffeine and sucrose on urinary mineral excretion of healthy adolescents. Nutr. Res. 1988; 8: 1005–12.CrossRefGoogle Scholar
15Massey, LK, Hollingbery, PW. Acute effects of dietary caffeine and aspirin on urinary mineral excretion in pre and postmenopausal women. Nutr. Res. 1988; 8: 845–51.CrossRefGoogle Scholar
16Barger-Lux, MJ, Heaney, RP, Stegman, MR. Effects of moderate caffeine intake on the calcium economy of premenopausal women. Am. J. Clin. Nutr. 1990; 52: 722–5.CrossRefGoogle ScholarPubMed
17Harris, SS, Dawson-Hughes, B.Caffeine and bone loss in healthy postmenopausal women. Am. J. Clin. Nutr. 1994; 60: 573–8.CrossRefGoogle ScholarPubMed
18Yano, K, Heilbrun, LK, Wasnich, RD, Hankin, JH, Vogel, JM. The relationship between diet and bone mineral content of multiple skeletal sites in elderly Japanese-American men and women living in Hawaii. Am. J. Clin. Nutr. 1985; 42: 877–88.CrossRefGoogle ScholarPubMed
19Bauer, DC, Browner, WS, Cauley, JA, et al. Factors associated with appendicular bone mass in older women. The study of osteoporotic fractures research group. Ann. Intern. Med. 1993; 118: 657–65.CrossRefGoogle Scholar
20Hernandez-Avila, M, Stampfer, MJ, Ravnikar, VA, et al. Caffeine and other predictors of bone density among pre-and perimenopausal women. Epidemiology 1993; 4: 128–34.CrossRefGoogle ScholarPubMed
21Barrett-Connor, E, Chang, JC, Edelstein, SL. Coffee-associated osteoporosis offset by daily milk consumption. JAMA 1994; 271: 280–3.CrossRefGoogle ScholarPubMed
22Johansson, C, Mellstrom, D, Lerner, U, Osterberg, T.Coffee drinking: a minor risk factor for bone loss and fractures. Age Ageing 1992; 21: 20–6.CrossRefGoogle ScholarPubMed
23Daniell, HW. Osteoporosis of the slender smoker. Vertebral compression fractures and loss of metacarpal cortex in relation to postmenopausal cigarette smoking and lack of obesity. Arch. Intern. Med. 1976; 136: 298304.CrossRefGoogle ScholarPubMed
24Eliel, LP, Smith, LC, Ivey, JL, Baylink, DJ. Longitudinal changes in radial bone mass. Dietary caffeine, milk and activity. Calcif. Tissue Int. 1983; 35: 669.Google Scholar
25Slemenda, CW, Hui, SL, Longcope, C, Johnston, CC. Sex steroids and bone mass. A study of changes about the time of menopause. J. Clin. Invest. 1987; 80: 1261–9.CrossRefGoogle ScholarPubMed
26Picard, D, Ste-Marie, LG, Coutu, D, et al. Premenopausal bone mineral contents relates to height, weight and calcium intake during early adulthood. Bone Miner. 1988; 4: 299309.Google Scholar
27Hansen, MA, Overgaard, K, Riis, BJ, Christiansen, C.Potential risk factors for development of postmenopausal osteoporosis – examined over a 12-year period. Osteoporosis Int. 1991; 1: 95102.CrossRefGoogle Scholar
28Lloyd, T, Rollings, N, Eggli, DF, Kieselhorst, KChinchilli, VM. Dietary caffeine intake and bone status of postmenopausal women. Am. J. Clin Nutr. 1997; 65: 1826–30.CrossRefGoogle ScholarPubMed
29Kiel, DP, Felson, DT, Hannan, MT, Anderson, JJ, Wilson, PWF. Caffeine and the risk of hip fracture: the Framingham study. Am. J. Epidemiol. 1990; 132: 675–84.CrossRefGoogle ScholarPubMed
30Hunter, DJ, Hernandez-Avila, M, Stampfer, MJ, et al. Caffeine, moderate alcohol intake, smoking, and risk of fractures of the hip and forearm among middle-aged women. Osteoporose: pour une prevention nutritionnelle du risque? Colloque International. Paris: CERIN, 1992; 139–52.Google Scholar
31Cummings, SR, Nevitt, MC, Browner, WS, et al. Risk factors for hip fractures in white women. N. Engl. J. Med. 1995; 332: 767–73.CrossRefGoogle ScholarPubMed
32Meyer, HE, Pedersen, JI, Løken, EB, Tverdal, A.Dietary factors and the incidence of hip fracture in middle-aged Norwegians: a prospective study. Am. J. Epidemiol. 1997; 145: 117–23.CrossRefGoogle ScholarPubMed
33Holbrook, TL, Barrett-Connor, E, Wingard, DL. Dietary calcium and risk of hip fracture: 14-year prospective population study. Lancet 1988; 2: 1046–9.CrossRefGoogle ScholarPubMed
34Kreiger, N, Gross, A, Hunter, G.Dietary factors and fracture in postmenopausal women: a case–control study. Int. J. Epidemiol. 1992; 21: 953–8.CrossRefGoogle ScholarPubMed
35Nieves, JW, Grisso, JA, Kelsey, JL. A case–control study of hip fracture: evaluation of selected dietary variables and teenage physical activity. Osteoporosis Int. 1992; 2: 122–7.CrossRefGoogle ScholarPubMed
36Tavani, A, Negri, E, La Vecchia, C.Coffee intake and risk of hip fracture in women in northern Italy. Prev. Med. 1995; 24: 396400.CrossRefGoogle ScholarPubMed
37Johnell, O, Gullberg, B, Kanis, JA, et al. Risk factors for hip fracture in European women: the MEDOS study. J. Bone Miner. Res. 1995; 10: 1802–15.CrossRefGoogle ScholarPubMed
38Fujiwara, S, Kasagi, F, Yamada, M, Kodama, K.Risk factors for hip fracture in a Japanese cohort. J. Bone Miner. Res. 1997; 12: 9981004.CrossRefGoogle Scholar
39Kelsey, JL, Browner, WS, Seeley, DG, Nevitt, MCCummings, SR. Risk factors for fractures of the distal forearm and proximal humerus. Am. J. Epidemiol. 1992; 135: 477–89.CrossRefGoogle ScholarPubMed
40Mezey, E, Potter, JJ, Merchant, CR. Effect of ethanol feeding on bone composition in the rat. Am. J. Clin. Nutr. 1979; 32: 25–9.CrossRefGoogle Scholar
41Baran, DT, Teitelbaum, SL, Bergfeld, MA, Parker, G, Cruvant, EM, Avioli, LV. Effect of alcohol ingestion on bone and mineral metabolism in rats. Am. J. Physiol. 1980; 238: E507–10.Google Scholar
42Peng, TC, Garner, SC, Frye, GD, Crenshaw, MA. Evidence of a toxic effect of ethanol on bone in rats. Alcohol Clin. Exp. Res. 1982; 6: 96–9.CrossRefGoogle Scholar
43Turner, RT, Greene, VS, Bell, NH. Demonstration that ethanol inhibits bone matrix synthesis and mineralization in the rat. J. Bone Miner. Res. 1987; 2: 61–6.CrossRefGoogle ScholarPubMed
44De Vernejoul, MC, Bielakoff, J, Herve, M, et al. Evidence for defective osteoblastic function. A role for alcohol and tobacco consumption on osteoporosis in middle-aged men. Clin. Orthop. 1983; 179: 107–15.CrossRefGoogle Scholar
45Lalor, BC, France, MW, Powell, D, Adams, PH, Counihan, TB. Bone and mineral metabolism and chronic alcohol abuse. Q. J. Med. 1986; 59: 497511.Google ScholarPubMed
46Diamond, T, Stiel, D, Lunzer, M, Wilkinson, M, Posen, S.Ethanol reduces bone formation and may cause osteoporosis. Am. J. Med. 1989; 86: 282–7.CrossRefGoogle ScholarPubMed
47Crilly, RG, Anderson, C, Hogan, D, Delaquerrier-Richardson, L.Bone histomorphometry, bone mass, and related parameters in alcoholic males. Calcif. Tissue Int. 1988; 43: 269–76.CrossRefGoogle ScholarPubMed
48Lindholm, J, Steiniche, T, Rasmussen, E, et al. Bone disorder in men with chronic alcoholism: a reversible disease? J. Clin. Endocrinol. Metab. 1991; 73: 118–24.CrossRefGoogle ScholarPubMed
49Bilke, DD, Genant, HK, Cann, C, Recker, RR, Halloran, BP, Strewler, GJ. Bone disease in alcohol abuse. Ann. Intern. Med. 1985; 103: 42–8.Google Scholar
50Feitelberg, S, Epstein, S, Ismail, F, D'Amanda, C.Deranged bone mineral metabolism in chronic alcoholism. Metabolism 1987; 36: 322–6.CrossRefGoogle ScholarPubMed
51Nilsson, BE, Westlin, NE. Femur density in alcoholism and after gastrectomy. Calcif. Tissue Res. 1972; 10: 167–70.CrossRefGoogle ScholarPubMed
52Nilsson, BE, Westlin, NE. Changes in bone mass in alcoholics. Clin. Orthop. 1973; 90: 229–32.Google Scholar
53Stevenson, JC, Lees, B, Devenport, M, Cust, MP, Ganger, KF. Determinants of bone density in normal women: risk factors for future osteoporosis? BMJ 1989; 298: 924–8.CrossRefGoogle ScholarPubMed
54Bjorneboe, GA, Bjorneboe, A, Johnsen, J, et al. Calcium status and calcium-regulating hormones in alcoholics. Alcohol Clin. Exp. Res. 1988; 12: 229–32.CrossRefGoogle ScholarPubMed
55Elders, PJM, Netelenbos, JC, Lips, P, et al. Perimenopausal bone mass and risk factors. Bone Miner. 1989; 7: 289–99.CrossRefGoogle ScholarPubMed
56Laitinen, K, Valimake, M, Lamberg-Allardt, C, et al. Deranged vitamin D metabolism but normal bone mineral density in Finnish noncirrhotic male alcoholics. Alcohol Clin. Exp. Res. 1990; 14: 551–6.CrossRefGoogle ScholarPubMed
57Cheng, S, Suominen, H, Rantanen, T, Parkatti, THeikkinen, E.Bone mineral density and physical activity in 50–60 year-old women. Bone Miner. 1991; 12: 123–32.CrossRefGoogle ScholarPubMed
58Gilfillan, CP, Silberberg, S, Scrivenor, P, Griffiths, RC, McCloud, PI, Burger, HG. Determinants of forearm mineral density and its correlation with fracture history in women. Maturitas 1995; 20: 199208.CrossRefGoogle Scholar
59Takada, H, Washino, K, Iwata, H.Risk factors for low bone mineral density among females: the effect of lean body mass. Prev. Med. 1997; 26: 633–8.CrossRefGoogle ScholarPubMed
60Angus, RM, Sambrook, PM, Pocock, NA, Eisman, JA. Dietary intake and bone mineral density. Bone Miner. 1988; 4: 265–77.Google ScholarPubMed
61Laitinen, K, Valimake, M, Keto, P.Bone mineral density measured by dual-energy x-ray absorptiometry in healthy Finnish women. Calcif. Tissue Int. 1991; 48: 224–31.CrossRefGoogle ScholarPubMed
62Orwoll, ES, Bauer, DC, Vogt, TM, Fox, KM. Axial bone mass in older women. Ann. Intern. Med. 1996; 124: 187–96.CrossRefGoogle ScholarPubMed
63Hingson, R, Howland, J.Alcohol as a risk factor for injury or death resulting from accidental falls: a review of the literature. J. Stud. Alcohol 1987; 48: 212–19.CrossRefGoogle ScholarPubMed
64Folsom, AR, Kaye, SA, Potter, JD, Prineas, RJ. Association of incident carcinoma of the endometrium with body weight and fat distribution in older women: early findings of the Iowa Women's Health Study. Cancer Res. 1989; 49: 6828–31.Google ScholarPubMed
65Willett, WC, Sampson, L, Brown, ML, et al. The use of a self-administered questionnaire to assess diet four years in the past. Am. J. Epidemiol. 1988; 127: 188–99.CrossRefGoogle ScholarPubMed
66Willett, WC, Sampson, L, Stampfer, MJ, et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am. J. Epidemiol. 1985; 122: 5165.CrossRefGoogle ScholarPubMed
67Giovannucci, E, Colditz, G, Stampfer, MJ, et al. The assessment of alcohol consumption by a simple self-administered questionnaire. Am. J. Epidemiol. 1991; 133: 810–17.CrossRefGoogle ScholarPubMed
68Munger, RG, Folsom, AR, Kushi, LH, Kaye, SA, Sellers, TA. Dietary assessment of older Iowan women with a food frequency questionnaire: nutrient intake reproducibility and comparison with 24-hour dietary recall interviews. Am. J. Epidemiol. 1992; 136: 192200.CrossRefGoogle Scholar
69Kushi, LH, Kaye, SA, Folsom, AR, Soler, JT, Prineas, RJ. Accuracy and reliability of self-measurements of body girths. Am. J. Epidemiol. 1988; 128: 740–8.CrossRefGoogle ScholarPubMed
70Felson, DT, Kiel, DP, Anderson, JJ, Kannel, WB. Alcohol consumption and hip fractures: the Framingham study. Am. J. Epidemiol. 1988; 128: 1102–10.CrossRefGoogle ScholarPubMed
71Huang, Z, Himes, JH, McGovern, PG. Nutrition and subsequent hip fracture risk among a national cohort of white women. Am. J. Epidemiol. 1996; 144: 124–34.CrossRefGoogle ScholarPubMed
72Gavaler, JS, Love, K, Van Thiel, D, et al. An international study of the relationship between alcohol consumption and postmenopausal estradiol levels. Alcohol and Alcoholism 1991; 1(Suppl.): 327–30.Google Scholar
73Holbrook, TL, Barrett-Connor, E.. A prospective study of alcohol consumption and bone mineral density. BMJ 1993; 306: 1506–9.CrossRefGoogle ScholarPubMed
74Pietinen, P, Hartman, AM, Haapa, E, et al. Reproducibility and validity of dietary assessment instruments. I. A self-administered food use questionnaire with a portion size picture booklet. Am. J. Epidemiol. 1988; 128: 655–66.CrossRefGoogle Scholar
75Pietinen, P, Hartman, AM, Haapa, E, et al. Reproducibility and validity of dietary assessment instruments. II. A qualitative food frequency questionnaire. Am. J. Epidemiol. 1988; 128: 667–76.CrossRefGoogle Scholar
76Farmer, ME, White, LR, Brody, JA, Bailey, KR. Race and sex differences in hip fracture incidence. Am. J. Public Health 1984; 74: 1374–80.CrossRefGoogle ScholarPubMed
77Cleghorn, DB, Polley, KJ, Nordin, BEC. Fracture rates calculated from fracture histories in normal postmenopausal women. J. Epidemiol. Community Health 1992; 46: 133–5.CrossRefGoogle ScholarPubMed
78Colditz, GA, Martin, P, Stampfer, MJ, et al. Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am. J. Epidemiol. 1986; 123: 894900.CrossRefGoogle Scholar
79Bush, TL, Miller, SR, Golden, AL, Hale, WE. Self-report and medical record report agreement of selected medical conditions in the elderly. Am. J. Public Health 1989; 79: 1554–6.CrossRefGoogle ScholarPubMed
80Nevitt, MC, Cummings, SR, Browner, WS, et al. The accuracy of self-report of fractures in elderly women: evidence from a prospective study. Am. J. Epidemiol. 1992; 135: 490–9.CrossRefGoogle ScholarPubMed
81Munger, RG, Cerhan, JR, Chiu, BC-H. Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women. Am. J. Clin. Nutr. 1999; 69: 147–52.CrossRefGoogle ScholarPubMed
82LaVecchia, C, Negri, E, Levi, F, Baron, JA. Cigarette smoking, body mass and other risk factors for fractures of the hip in women. Int. J. Epidemiol. 1991; 20: 671–7.CrossRefGoogle Scholar
83Tuppurainen, M, Kroger, H, Honkanen, R, et al. Risks of perimenopausal fractures – a prospective population-based study. Acta Obstet. Gynecol. Scand. 1995; 74: 624–8.CrossRefGoogle ScholarPubMed
84Kiel, DP, Baron, JA, Anderson, JJ, Hannan, MT, Felson, DT. Smoking eliminates the protective effect of oral oestrogens on the risk for hip fracture among women. Ann. Intern. Med. 1992; 116: 716–21.CrossRefGoogle ScholarPubMed
85Johnell, O, Nilsson, BE. Life-style and bone mineral mass in perimenopausal women. Calcif. Tissue Int. 1984; 36: 354–6.CrossRefGoogle ScholarPubMed
86Kleerekoper, M, Peterson, E, Nelson, D, et al. Identification of women at risk for developing postmenopausal osteoporosis with vertebral fractures: role of history and single photon absorptiometry. Bone Miner. 1989; 7: 171–86.CrossRefGoogle ScholarPubMed
87Dawson-Hughes, B, Harris, SS, Krall, EA, Dallal, GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N. Engl. J. Med. 1997; 337: 670–6.CrossRefGoogle ScholarPubMed
88Recker, RR, Hinders, S, Davies, KM, et al. Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J. Bone Miner. Res. 1996; 11: 1961–6.CrossRefGoogle ScholarPubMed