Question

• Do adolescents who drink carbonated beverages have a higher rate of fractures compared to those who don't drink them?

Clinical Bottom Lines

1. Physically active adolescent girls who have had bone fractures were more likely to consume both cola and non-cola drinks.
2. For less active girls, the association between carbonated cola beverages and bone fractures is marginal.
3. Good nutrition histories should be obtained in adolescent, including milk intake and carbonated soft drink intake.
4. Adolescents should be counseled on the potential increased risk of bone fractures with consumption of carbonated beverages, especially highly active girls.
5. This is further evidence to remove pop machines from schools.

Summary of Key Evidence

1. 460 9th and 10th grade girls participated in the study.¹
2. A survey was conducted to assess carbonated beverage intake, bone fractures, physical activity, smoking history, etc.
3. Bone fractures that occurred before age 8 were excluded because they were not likely to be associated with carbonated beverages.
4. 80% reported drinking carbonated beverages (49.8% cola only, 11.5% noncola only, 15% both)
5. For all girls, the association between drinking carbonated beverages and bone fractures showed an odds ratio (OR) of 3.14.
6. Comparing physically active girls who drank cola with those who drank no carbonated beverages or non-cola beverages showed an OR of 4.94
7. Comparing physically active girls who drank both cola and non-cola beverages with those who did not drink carbonated beverages showed an OR of 7.49.

Additional Comments

• This study concurs with other studies that physically active adolescents who drink cola beverages have a higher risk of bone fractures.
• The association observed may be because of the phosphoric acid content in cola drinks.
• Although studies cannot attribute a causative relationship between carbonated beverage consumption and bone fractures, they suggest that carbonated beverages may displace more nutritious beverages in the adolescent diet.²
• Observational studies often have prognostic factors that are not known or measured, which may result in a difference in outcomes (calcium intake, genetics, puberty status).
• Studies that assess harm have the potential for recall bias.
  

Citation

1. Wyshak G. Teenaged girls, carbonated beverage consumption and bone fractures. Arch Pediatr Adol Med 2000;154:610-3.
2. McGartland C, Robson PJ, Murray L, et al. Carbonated soft drink consumption and bone mineral density in adolescence: the Northern Ireland Young Hearts project. J Bone Min Res 2003;18:1563-9.

CAT Author: Elizabeth Oh, MD

CAT Appraisers: John Frohna, MD

Date appraised: April 26, 2006