Association of Sweetened Beverages with Risk of Osteoporosis and First Fractures: Evidence from the United Kingdom Biobank

Abstract

We investigated the associations between intake of sugar-sweetened, artificially sweetened, and naturally sweetened beverages (SSBs, ASBs, and NSBs) and osteoporosis and first incident fracture risks. We analyzed data from 171,694 to 168,366 United Kingdom Biobank participants (mean age: 55.8 +/- 7.96 years; 53.9% and 52.9% women, respectively) for osteoporosis and fracture outcomes. Median follow-up durations were 13.5 and 13.4 years, respectively. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). High ASB intake (> 1 serving/day) was associated with increased osteoporosis (HR, 1.29 [95% CI 1.14-1.47]) and fracture risk (HR: 1.11; 95% CI 1.01-1.22]). Moderate NSB intake (> 0-1 serving/day) was associated with reduced osteoporosis risk (HR: 0.88; 95% CI 0.83-0.93), particularly among individuals aged < 60 years (HR: 0.84; 95% CI 0.78-0.91). Among women, moderate NSB intake was protective (HR: 0.86; 95% CI 0.80-0.92), whereas among men, higher intake (> 1 serving/day) showed benefits (HR: 0.72; 95% CI 0.54-0.97). Among participants with hypertension, high NSB intake was linked to increased incident fracture risks (HR: 1.23; 95% CI 1.05-1.44). Moderate SSB intake was associated with slightly decreased incident fracture risks (HR: 0.92; 95% CI 0.88-0.97), whereas higher intake was not significantly associated. High ASB intake correlated with increased osteoporosis and fracture risks. Conversely, moderate NSB intake appeared protective, particularly in younger individuals and women. These findings highlight that beverage type, quantity, and individual characteristics may influence bone health.