American Journal of Epidemiology Vol. 132, No. 4: 675-684
Copyright © 1990 by The Johns Hopkins University School of Hygiene and Public Health
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CAFFEINE AND THE RISK OF HIP FRACTURE: THE FRAMINGHAM STUDY
1Division of General Internal Medicine, Brown University Program in Medicine and Rhode Island Hospital Providence, RI
2Boston University Multipurpose Arthritis Center and the Department of Medicine, Boston City Hospital Boston, MA
3Framingham Study, Framingham, MA
Reprint requests to Dr. Douglas P. Kiel, Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903.
Caffeine increases urinary calcium output and has been implicated as a risk factor for osteoporosis. The authors examined the effect of caffeine on hip fracture risk in 3,170 individuals attending the 12th (1971–1973) Framingham Study examination. Coffee and tea consumption, age, Framingham examination number, weight, smoking, alcohol consumption, and estrogen use were used to evaluate hip fracture risk according to caffeine intake. Hip fractures occurred in 135 subjects during 12 years of follow-up. Fracture risk over each 2-year period increased with increasing caffeine intake (one cup of coffee = one unit of caffeine, one cup of tea = 
unit of caffeine). For intake of 1.5–2.0 units per day, the adjusted relative risk (RR) of fracture was not significantly elevated compared with intake of one or less units per day. Consumption of 
2.5 units per day significantly increased the risk of fracture. Overall, intake of greater than two cups of coffee per day (four cups of tea) increased the risk of fracture. In summary, hip fracture risk was modestly increased with heavy caffeine use, but not for intake equivalent to one cup of coffee per day. Since caffeine use may be associated with other behaviors that are, themselves, risk factors for fracture, the association may be indirect. Further studies should be performed to confirm these findings.
caffeine; coffee; cohort studies; hip fractures; osteoporosis; tea
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