Young People Get Osteoporosis Too 

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Soda and Osteoporosis: Is There a Connection?
Does this sound like you? While everyone else is at Starbucks getting their morning latte, you're at the vending machine picking up a Diet Coke. And if you're going to a movie, the popcorn just wouldn’t be complete without a large soda. But there may be a link between soda and osteoporosis that could be putting your bones at risk.

When Soda Displaces Milk
Experts aren’t sure why drinking soda is linked to osteoporosis. It may be simply that the soda is displacing healthier drinks in your diet. If you're guzzling a Pepsi with dinner (or breakfast!) you're probably not drinking the glass of milk or fortified orange juice that nutritionists recommend.

"There is an association between people who have high soda intake and risk of fracture, but that's probably due to the fact that if they have a high soda intake, they have a low milk intake," agrees Robert Heaney, MD, FACP, a professor of medicine at Creighton University in Omaha, Neb., and a nationally recognized expert on osteoporosis.

"Those things have been shown to be linked in various studies. But when you look at the ingredients of the soda and give those to healthy people and measure what it does to their calcium composition, nothing happens at all."

"Individuals who drink a lot of soft drinks aren't going to drink as much nutritious liquid as others," says Bess Dawson-Hughes, M.D., professor of medicine and director of the Bone Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. "We're simply not going to consume beyond a certain volume each day."

So, if you just remember to drink a glass of milk for every can of Diet Coke, you'll be fine, right? Not necessarily.

Soda and Osteoporosis: The Cola Connection
New research indicates that there may be more to the soda and osteoporosis connection than simply replacing the good stuff with the useless stuff.

Researchers at Tufts University, studying several thousand men and women, found that women who regularly drank cola-based sodas -- three or more a day -- had almost 4% lower bone mineral density in the hip, even though researchers controlled for calcium and vitamin D intake. But women who drank non-cola soft drinks, like Sprite or Mountain Dew, didn't appear to have lower bone density.

Soda and Osteoporosis: Possible Culprits
Phosphoric acid, a major component in most sodas, may be to blame, according to lead study author Katherine Tucker, PhD.

Phosphorus itself is an important bone mineral. But if you're getting a disproportionate amount of phosphorus compared to the amount of calcium you're getting, that could lead to bone loss.

Another possible culprit is caffeine, which experts have long known can interfere with calcium absorption. In the Tufts study, both caffeinated and non-caffeinated colas were associated with lower bone density. But the caffeinated drinks appeared to do more damage.

This study isn't the last word on the subject. Some experts point out that the amount of phosphoric acid in soda is minimal compared to that found in chicken or cheese. And no one's telling women to stop eating chicken.


Smart Steps for Soda Lovers
Whether the apparent soda and osteoporosis link is due to effects of the soda itself or simply because soda
drinkers get less of other, healthier beverages, it's clear that you need to be extra-vigilant about your bone health if you're a soda fiend. "Soda drinkers need to pay extra attention to getting calcium from other sources," says Dawson-Hughes.


A few steps you can take to boost your bone health:

Can't give soda up entirely?

  • Cut out one or two cans a day (depending on how much you drink). The Tufts study indicates that it might help to switch to a non-cola soda (like Sprite or Mountain Dew). Better still, for every soda you skip, reach for a glass of milk or fortified orange juice instead. Not only will you be cutting back on any harmful effect from the soda itself, you'll be adding calcium. (If you're a diet soda drinker worried about calories, here's a plus: fat-free milk has even more calcium than higher-calorie whole milk.)
  • Have a breakfast cereal fortified with calcium -- and pour milk on top.
  • Add milk instead of water when you prepare things like pancakes, waffles, and cocoa.
  • Add nonfat powdered dry milk to all kinds of recipes -- puddings, cookies, breads, soups, gravy, and casseroles. One tablespoon adds 52 mg of calcium. You can add three tablespoons per cup of milk in puddings, cocoa and custard; four tablespoons per cup of hot cereal (before cooking); and 2 tablespoons per cup of flour in cakes, cookies and breads.
  • Take a calcium and vitamin D supplement if you aren't getting enough calcium (1000-1300 mg, depending on your age) in your diet.
  • Get plenty of weight-bearing and resistance exercise.



The following information is an excerpt from the web site of Dr. Miriam Nelson, the best-selling author of Strong Women Strong Bones:

Last month's newsletter answered a question from a reader who had heard that carbonated beverages are harmful to bones. I replied that there's no evidence of such a danger - so long as healthy drinks, like milk or fruit juice, aren't replaced by the empty calories of sugary sodas. Many readers wrote to say that they'd heard otherwise.

This query was typical:

"Rumor in the health-conscious community has it that the phosphorus in carbonated beverages interferes with the body's proper absorption of calcium. Is this not true?"

Indeed, this is not true. Because there's widespread misinformation about soda and phosphorus, I want to provide a fuller answer.
Phosphorus is an essential mineral, one of the body's building blocks for bone. The Dietary Reference Intake (DRI) for phosphorus is 700 mg per day for adult women. Though many women don't get enough calcium in their diet, insufficient phosphorus is seldom a problem because phosphorus is abundant in many common foods. But calcium metabolism can suffer when you consume considerably more phosphorus than calcium. This is because both calcium and phosphorus require vitamin D for proper metabolism. If there's an excess of phosphorus, less vitamin D is available for processing calcium, so calcium absorption is reduced.

Could soda consumption cause a phosphorus excess?

 Very unlikely. Many sodas have no phosphorus at all - and even those that do contain phosphorus have modest amounts compared to other common foods.

There's no phosphorus at all in club soda or seltzer, according to the USDA Nutrient Database for Standard Reference (1998). Sodas that do have phosphorus contain well less than 100 milligrams per 8-ounce serving. Here are a few typical examples:

Coca-Cola (8 oz)
Diet Coke (8 oz)
Tab (8 oz)
Sprite (8 oz)
Minute Maid orange (8 oz)
Source: Coca-Cola USA

To put these quantities in perspective, let's look at some other foods. Among the most significant sources of phosphorus in the typical American diet are whole grains (including cereal), meat, poultry and dairy foods. Some examples:

Whole wheat bread (1 slice)
Kellogg's All Bran (1/2 cup)
Cheerios (1 cup)
Ground beef, lean, grilled (3 oz)
Chicken breast, no skin, roasted (3 oz)
Cottage cheese, low fat (4 oz)
Skim milk, 1% (8 oz)
Source: Online USDA Nutrient Database

In other words, you'd have to drink more than two six-packs of Diet Coke to ingest as much phosphorous as you'd get from a modest serving of All Bran and skim milk.

Reducing soda consumption to avoid phosphorus is like cutting back on carrots to save calories: Yes, carrots provide calories - but they're very unlikely to be a significant source of excess calories in your diet.

Finally, there are two legitimate bone-related concerns involving soda.

One, which I mentioned last month, is that some people - especially teenagers - may drink soda instead of milk and consequently they don't get enough calcium.

The other possible issue is caffeine, an ingredient in many colas and other sodas. Caffeine has a diuretic effect and can interfere with calcium absorption if you consume more than 400 milligrams per day (the equivalent of about four cups of coffee). If you're already close to that limit with coffee, and also drink several glasses of caffeine-containing soda daily, you might want to cut back or switch to decaffeinated. Typically, sodas that contain caffeine have about as much as teas that contain caffeine - considerably less than coffee. But check the label for exact amounts. For example, an 8-ounce glass of regular Coca-Cola contains 31 milligrams of caffeine; there's none in the caffeine-free version.


Nelson, Miriam E. and Wernick, Sarah (2006).  " Strong Women, Strong Bones: everything you need to know to prevent, treat and beat osteoporosis" pp 111


this site was last updated on 07/19/2007