A study recently released in the journal Clinical Nutrition examining associations between nutrition and hip fracture risk in women determined that intake of coffee, tea, and protein had a protective effect against hip fracture among underweight women.

The research explored a cohort of more than 26,000 UK-based women aged 35 to 69, who were followed for a median of 22.3 years.  Approximately 3% of the women in the study experienced a hip fracture.

Fracture risk by the numbers

According to recent data from the Mayo Clinic (May 2020), hip fractures occur in women about 3 times more frequently than they do in men in the United States.

Underscoring that prevalence, the Center for Disease Control and Prevention (CDC) cites that women suffer three-quarters of all hip fractures, fall more often than men, and are more likely to have osteoporosis which weakens bones, making them more likely to break.  Further, bone density loss occurs faster in women than men, in part because of the accelerated bone loss occurring due to the drop in estrogen levels concomitant with menopause.

Protective protein—plus

In the recent study, researchers utilized data regarding the women’s diets and hip fracture cases from the UK Women’s Cohort Study to estimate associations between standard portions of food and nutrient intakes and hip fracture risk.  At recruitment, participants were asked to fill out questionnaires about their diet and lifestyle.  This information was then linked with hospital records over the following 2 decades, which revealed how many women had suffered a hip fracture or had had a hip replaced.

After adjusting for confounders, the researchers determined that an increase of 25 grams per day of dietary protein intake was associated with a 14% lower risk of hip fracture on average.  The study further found that every additional cup of tea or coffee per day was associated with a 4% lower risk of hip fracture.

Underweight women benefitted

When body mass index (BMI) was taken into account, the researchers found this association existed among underweight women, but not among healthy-weight or overweight participants.

In particular, they wrote, “the risk of hip fracture in underweight participants (28 cases, 545 participants) was 45% lower for every 25g/day protein consumed.”

Interestingly, the findings revealed no clear evidence of overall associations between hip fracture risk and participants’ dietary intake of calcium, vitamin D, or animal products—although there was some evidence of stronger inverse associations in underweight women for these foods and nutrients.

Why the coffee and tea effect?

The authors note that tea and coffee are high in biologically active compounds such as polyphenols and phytoestrogens, particularly catechins, which may enhance osteoblast activity and suppress osteoclastic activity by reducing oxidative stress, resulting in higher bone mineral density (BMD) and lower risk of hip fracture.

In their study, a stronger association was observed for tea consumption in underweight women, leading them to hypothesize that “tea could help to mitigate the low BMD-induced increase in hip fracture risk that may be more prominent at a lower BMI.”  They note, however, that further research is needed to clarify associations between tea and coffee consumption and hip fracture risk and that such future study should seek to ascertain whether “associations depend on the type of tea or coffee consumed and the amount of milk or sugar added, since polyphenol and nutrient contents vary.”

Overall, their findings suggest that a higher protein intake and consumption of tea and coffee may each independently reduce risk of hip fracture in a linear dose-response manner, though confidence intervals were wide for protein, and a large number of exposures were considered.

Diet as a tool

The authors contend that theirs is one of the first to investigate relationships between food and nutrient intakes and risk of hip fracture, with hip fractures being accurately identified through hospital records.  Among their chief takeaways for women’s health clinicians is that diet is a factor that can be modified to protect patients from hip fracture by maintaining healthy bones and muscles.

They called for providers to pay particular attention to their patients who may follow alternative diet regimens, a cohort that, across Western societies, is more than twice as likely as men to be vegan or vegetarian (Browarnik et al. 2012; Rudy K. 2012, and Trocchia, P.J. et al. 2003).  Professor Janet Cade, who participated in the study, observed in the press release issued in concert with the study’s publication, “In the U.K., most people eat an adequate amount of protein, however, certain groups such as vegetarians or vegans need to check that their protein intakes are high enough for good health.”

Click to read cost free the complete findings of “Foods, nutrients and hip fracture risk: A prospective study of middle-aged women.”

Clinicians’ Bonus:  More To Know

Resources for you and your patients

 For You

Don’t miss NPWH’s “Osteoporosis and fracture prevention” continuing education (CE) activity available now through June 30, 2023.  This activity has been evaluated and approved by the Continuing Education Approval Program of the National Association of Nurse Practitioners in Women’s Health and has been approved for 1 contact hour CE credit, including 0.50 hours of pharmacology credit.   Authored by Nancy R. Berman, MSN, ANP-BC, NCMP, FAANP, the course is intended to provide participants with knowledge about screening and risk assessment recommendations, how to interpret findings, and how to individualize pharmacologic treatment for postmenopausal osteoporosis to help older women avoid fractures that significantly affect quality of life.

For Your Patients

The CDC has developed a concise but comprehensive 4-page, no cost, downloadable PDF for your patients called the MyMobility Plan.  The tool walks your patients through 3 sections:  Myself: How to stay independent – Tips to manage your health to maintain mobility; MyHome: How to stay safe at home – A home safety checklist to help prevent falls; and MyNeighborhood: How to stay mobile in your community – A plan to get around in your community.

The MyMobility Plan and related documents are also available in Spanish and, using this version, providers may customize with your organization’s name and address.  There is also a designated space provided for you to add contact information.

The contents of this feature are not provided or reviewed by NPWH.