Rossouw, Linda Pottern, Shari Ludlam, Joan McGowan, and Nancy Morris. Clinical Coordinating Center : Fred Hutchinson Cancer Research Center, Seattle, Washington: Ross Prentice, Garnet Anderson, Andrea LaCroix, Ruth E.

Patterson, and Anne McTiernan; Bowman Gray School of Medicine, Winston-Salem, North Carolina: Sally Shumaker and Pentti Rautaharju; Medical Research Laboratories, Highland Heights, Kentucky: Evan Stein; University of California at San Francisco, San Francisco, California: Steven Cummings; University of Minnesota, Minneapolis, Minnesota: John Himes; and University of Washington, Seattle, Washington: Bruce Psaty.

Correspondence to Dr. Zhao Chen, Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, East Lee Street, Tucson, AZ e-mail: zchen u. Trevisanato SI, Kim YI. Tea and health.

Nutr Rev ; 58 : 1 — Mikuls TR, Cerhan JR, Criswell LA, et al. Arthritis Rheum ; 46 : 83 — Sueoka N, Suganuma M, Sueoka E, et al. A new function of green tea: prevention of lifestyle-related diseases. Ann N Y Acad Sci ; : — Hernandez-Avila M, Stampfer MJ, Ravnikar VA, et al.

Caffeine and other predictors of bone density among pre- and perimenopausal women. Epidemiology ; 4 : — Hoover PA, Webber CE, Beaumont LF, et al. Postmenopausal bone mineral density: relationship to calcium intake, calcium absorption, residual estrogen, body composition, and physical activity.

Can J Physiol Pharmacol ; 74 : — Hegarty VM, May HM, Khaw KT. Tea drinking and bone mineral density in older women. Am J Clin Nutr ; 71 : —7. Johnell O, Gullberg B, Kanis JA, et al. Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res ; 10 : — Wu CH, Yang YC, Yao WJ, et al.

Epidemiological evidence of increased bone mineral density in habitual tea drinkers. Arch Intern Med ; : —6. Kanis J, Johnell O, Gullberg B, et al. Risk factors for hip fracture in men from southern Europe: the MEDOS Study. Osteoporos Int ; 9 : 45 — Hakim IA, Harris RB, Weisgerber U.

Tea intake and skin squamous cell carcinoma: influence of type of tea beverages. Cancer Epidemiol Biomarkers Prev ; 9 : — Control Clin Trials ; 19 : 61 — Ware JE Jr, Sherbourne CD. The MOS item short-form health survey SF Conceptual framework and item selection. Med Care ; 30 : — Burnam MA, Wells KB, Leake B, et al.

Development of a brief screening instrument for detecting depressive disorders. Med Care ; 26 : — Barrett-Connor E, Chang JC, Edelstein SL.

Coffee-associated osteoporosis offset by daily milk consumption. The Rancho Bernardo Study. JAMA ; : —3. Sakamoto W, Nishihira J, Fujie K, et al. Effect of coffee consumption on bone metabolism. Bone ; 28 : —6. Lloyd T, Johnson-Rollings N, Eggli DF, et al. Bone status among postmenopausal women with different habitual caffeine intakes: a longitudinal investigation.

J Am Coll Nutr ; 19 : — Debry G. Coffee and health. London, United Kingdom: John Libbey and Company, Ltd, — Hollman PC, Katan MB. Health effects and bioavailability of dietary flavonols. Free Radic Res ; 31 suppl : S75 — Miksicek RJ.

Commonly occurring plant flavonoids have estrogenic activity. Mol Pharmacol ; 44 : 37 — Leveille SG, LaCroix AZ, Koepsell TD, et al. Dietary vitamin C and bone mineral density in postmenopausal women in Washington State, USA. J Epidemiol Community Health ; 51 : — Anderson JJB, Jones C, Chen X.

Effects of green tea catechins and caffeine on osteoblast-like cells in vitro. Presented at the annual meeting of the Federation of American Societies for Experimental Biology FASEB , New Orleans, LA, April 20—24, Riggs BL, Seeman E, Hodgson SF, et al.

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Abstract The purpose of this study was to prospectively investigate associations of habitual drinking of regular tea with bone mineral density and fracture risk. bone density; cohort studies; densitometry; fractures; osteoporosis, postmenopausal; tea; women.

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Tea is an important source of phytoestrogen and fluoride, both of which may help to maintain bone mineral density. However, regular tea not decaffeinated or herbal tea also contains caffeine that, in a high amount, may cause bone loss.

The impact of drinking regular tea on the risk of osteoporosis has not been studied before. Results from a previous study conducted in Arizona indicated that over 90 percent of tea drinkers consumed regular tea instead of decaffeinated tea The study population was a cohort from the nationwide WHI Observational Study.

Postmenopausal women aged 50—79 years were enrolled in the WHI Observational Study at 40 clinical centers throughout the United States. Details of the study methods were reported elsewhere In summary, women were recruited from communities where the WHI clinical centers are located.

Eligibility for the WHI Observational Study included postmenopausal status, stability being unlikely to move or die within 3 years , nonenrollment in the WHI clinical trials, and nonparticipation in any other current clinical trials.

As of August 31, , a total of 93, participants were enrolled in the WHI Observational Study. Excluding these participants left 91, women eligible for this study. At baseline, women completed self-administered or interviewer-administered questionnaires for eligibility screening and baseline characteristics such as demographic, reproductive, and health status data.

Physical examinations were conducted, and a blood specimen was collected. During the follow-up, women were sent questionnaires annually to update medical and other lifestyle information. The WHI Observational Study women visited the WHI clinical center at annual visit 3 to have additional physical measurements taken and to provide a blood specimen.

Additional follow-up data collections were done through annual mailed questionnaires. The average length of follow-up was 4. The WHI study protocol was reviewed and approved by human subjects review committees at each participating institution. All women in this study completed a WHI Observational Study questionnaire at baseline, in which separate questions about tea and coffee drinking were asked.

Women reported the occurrence of any clinical fractures by completing WHI follow-up questionnaires each year. Self-reports of hip fractures were confirmed by review of medical records.

Only confirmed hip fractures were used in this study. Other non-hip fracture data were all based upon self-report. Spinal fractures were self-reported clinical fractures of the thoracic or lumbar spine. Lower arm and wrist fractures were self-reported fractures of the radius, ulna, or carpal.

Other self-reported fractures in this study included fractures of the upper leg shaft of femur , pelvis, knee patella or tibial plateau , lower leg or ankle tibia, fibula, or talus , foot tarsal, metatarsal, heel, or calcaneus , tailbone sacrum or coccyx , hand metacarpal , elbow distal humerus, upper radius, or ulna , and upper arm, shoulder, or collarbone humerus, clavicle, or scapula.

Moderate-to-excellent agreements between self-reports of fractures and medical records were found for different skeletal sites, and these results will be reported in a separate paper. The positioning and analysis of these x-ray absorptiometry scans were performed according to standard WHI protocols by radiology technicians who were trained and certified by both the Hologic company and the WHI Bone Density Coordinating Center at the University of California, San Francisco.

In addition to daily and weekly phantom scans at each clinic, a set of calibration phantoms were also periodically circulated and scanned across dual-energy x-ray absorptiometry instruments in the WHI. The rate of study participants either withdrawn or lost to follow-up was 1.

A total of 5, participants had bone mineral density measurements at both the baseline visit and the annual visit 3 follow-up visit, but 1. Excluding women with incomplete bone mineral density or tea consumption information, we found that there were 4, participants in the bone mineral density cohort for analyses related to bone mineral density and tea consumption.

Because two of the three WHI bone mineral density centers were designated minority clinical sites, there was a slightly higher percentage of minorities enrolled in the bone mineral density cohort than in the entire WHI Observational Study.

Physical function and depression at baseline were measured using the item Medical Outcomes Study Scale 12 and the shortened Center for Epidemiologic Studies Depression Scale, respectively Weight was measured to the nearest 0.

Height was measured to the nearest 0. Results from the preliminary analysis indicated that the directions and magnitudes of the associations between tea and bone mineral density or fracture risk were similar between the groups drinking 6 or more cups per day and 4—5 cups per day.

Hence, women in the group drinking 6 or more cups per day were combined with the group drinking 4—5 cups per day for adequate statistical power in the analyses. Crude and adjusted least-squares mean bone mineral density measurements were reported for each tea-drinking group.

Multivariate linear regression analysis and the trend test were used to assess the associations of baseline tea drinking with bone mineral density measurements at annual visit 3 or the changes in bone mineral density by percentage from baseline to annual visit 3. The major covariates include ethnicity White as reference vs.

past or current , coffee drinking nondrinker vs. drinker , walking none vs. former or current. Multivariate analyses were also conducted in stratified samples by ethnicity and hormone replacement therapy to assess the strength of the associations between tea and bone mineral density in each subgroup.

Interaction terms between ethnicity or hormone replacement therapy and tea consumption were computed and tested for levels of significance. The variables included in the adjusted Cox models were age, body mass index, hormone replacement therapy use, smoking, years since menopause, fracture history broken bone at age 55 years or later, yes vs.

no , osteoporosis drug use yes vs. no , walking, soy milk consumption, coffee drinking, and depression yes vs. To examine if the association of fracture with tea consumption varied by ethnicity or hormone replacement therapy use, the relative risks and 95 percent confidence intervals within these subgroups were computed.

The statistical analyses were performed using SAS version 8. In all multivariate models, a complete-case approach was used for the handling of missing data. Adjusted variables were selected for the multivariate models based on results from previous studies and their effects on the study results in preliminary data analyses.

Most of the characteristics at baseline were comparable among tea consumption groups. However, Black women were less likely to drink tea in comparison with women from other ethnic groups. There was an apparent inverse correlation between tea drinking and coffee consumption table 1.

Baseline characteristics of the bone mineral density cohort are presented in table 2. The sample sizes were 3,, , , and , respectively, for the four tea groups from low to high tea consumption. The percentages of minority women in the bone mineral density cohort were higher in comparison with the total study population.

Table 3 displays the mean and 95 percent confidence intervals of the annual visit 3 bone mineral density measurements by tea consumption. There was a significant trend of increased total body bone mineral density with a higher level of tea consumption.

However, significant trends were not found for either total hip or lumbar spine bone mineral density. Models with the rates of change in bone mineral density measurements between baseline and annual visit 3 provided results similar to those of the models using annual visit 3 bone mineral density measurements as outcomes data not shown.

There were no significant interactions between ethnicity or hormone replacement therapy and tea consumption on bone mineral density data not shown. The other major fractures were fractures of the lower leg or ankle tibia, fibula, or talus , foot tarsal, metatarsal, heel, or calcaneus , and upper arm, shoulder, or collarbone humerus, clavicle, or scapula.

However, this association between other fracture risk and tea drinking was no longer significant when the analyses were restricted to the non-Hispanic White women only data not shown. Because of the small number of fractures in minority women, we were unable to examine the effect of tea drinking on fracture risk in these subgroups.

Unlike the previous cross-sectional study conducted among US pre- and perimenopausal women 4 , results from our US postmenopausal cohort do not support an inverse relation between tea drinking and bone mineral density.

Instead, we found a positive trend between daily consumption of regular tea and total body bone mineral density. The differences in menopausal status and skeletal sites measured may contribute to the discrepancies in research findings.

Tea may affect bone mineral density through several distinct mechanisms. First, tea is a rich source of caffeine. It has been suggested that caffeine intake is inversely related to bone mineral density by some studies 4 , 14 but not by all studies 15 , This discrepancy may be due partially to the addition of milk to coffee that could ameliorate the adverse effects of coffee drinking 6 , Although the caffeine content of the tealeaf is higher 2—3 percent vs.

Hence, an adverse effect of caffeine from tea on bone mineral density may be less significant. In our study after adjustment for coffee intake, drinking even up to 4 or more cups of regular tea per day did not show any adverse impact on bone mineral density. Tea is an important dietary source of flavonoids 18 , and some of them have weak estrogenic effects 19 and well-known antioxidation properties 20 , which may be beneficial for bone mineral density.

One recent study has also suggested that the catechins derived from green tea are potent stimulators of osteoblast-like cells in culture and that the effects on osteoblast-like cells are, at least in part, via estrogen receptors Furthermore, tea is a major dietary source of fluoride.

Fluoride is a very potent and highly bone-specific anabolic substance However, the role of fluoride in fracture prevention is still in debate.

Our results differ from the findings of the MEDOS Study 7 , 9 , in which a significant association between tea consumption and a reduced risk of hip fracture was observed in both women 7 and men 9. The MEDOS Study was a case-control study among people aged 50 years or over from 14 centers in six countries in southern Europe between and , while our study was conducted in a healthy and multiethnic cohort in the United States.

The MEDOS Study and WHI populations may consume different types of tea and possess different risk factors for hip fractures that likely contribute to the different results from the two studies.

The other fracture category in this study is a mixed group of fractures, some of which may be mainly caused by extrinsic factors, such as trauma.

Given the facts that the daily consumption of regular tea was associated with neither low bone mineral density nor increased risk of fracture at the major osteoporotic sites and that this increased risk of other fractures disappeared in the analyses stratified by ethic groups, the observed high risk for other fractures in the group drinking 2—3 cups of tea per day is likely caused by unidentified confounding factors.

This is the first cohort study investigating the effect of tea on the risk of osteoporosis. The strengths of our study include a prospective study design, large multiethnic populations, available information on a large range of covariates, and good assessments of both bone mineral density and clinical fractures.

However, participants in the WHI cohort may be a selected group of women who are willing to be followed for up to 9 years in the WHI Observational Study. How the selection bias may affect the study results is difficult to assess, but it should be taken into consideration when generalizing the results to other US populations.

It is possible that some of the women in our study drank tea sporadically or drank decaffeinated tea instead. Having no information for decaffeinated tea consumption and nondaily tea drinking in the reference group is a weakness of this study and may mask an association between tea consumption and bone mineral density or fractures.

According to a study conducted in Arizona, 33 percent of people may be occasional tea drinkers drink 1 cup of tea 1—5 times per week , and about 10 percent of the population may drink decaffeinated tea Because of the potential adverse effect of caffeine on bone density, we believe that not counting decaffeinated tea consumption in our study may lead to an underestimate of the strength of any positive association between bone density and tea consumption.

Black tea is the most common type of tea consumed by the American population. Whether black and green teas have different effects on bone health needs further investigation. In summary, our study suggests that, at the current level of tea consumption in the United States, the effect of drinking regular tea on bone mineral density is weak and unlikely to have any significant impact on fracture risk among the US postmenopausal women.

Future studies should include detailed assessments of tea consumption to delineate whether various tea preparations and types of tea, such as green versus black, have different contributions to bone mineral density measurements and the risk of fractures. is supported by a career development award 1 K01 AR from the Department of Health and Human Services, National Institutes of Health.

The following short list of WHI investigators is acknowledged. Program Office : National Heart, Lung, and Blood Institute, Bethesda, Maryland: Jacques E. Rossouw, Linda Pottern, Shari Ludlam, Joan McGowan, and Nancy Morris. Clinical Coordinating Center : Fred Hutchinson Cancer Research Center, Seattle, Washington: Ross Prentice, Garnet Anderson, Andrea LaCroix, Ruth E.

Patterson, and Anne McTiernan; Bowman Gray School of Medicine, Winston-Salem, North Carolina: Sally Shumaker and Pentti Rautaharju; Medical Research Laboratories, Highland Heights, Kentucky: Evan Stein; University of California at San Francisco, San Francisco, California: Steven Cummings; University of Minnesota, Minneapolis, Minnesota: John Himes; and University of Washington, Seattle, Washington: Bruce Psaty.

Correspondence to Dr. Zhao Chen, Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, East Lee Street, Tucson, AZ e-mail: zchen u. Trevisanato SI, Kim YI. Tea and health. Nutr Rev ; 58 : 1 — Mikuls TR, Cerhan JR, Criswell LA, et al.

Arthritis Rheum ; 46 : 83 — Sueoka N, Suganuma M, Sueoka E, et al. A new function of green tea: prevention of lifestyle-related diseases.

Ann N Y Acad Sci ; : — Hernandez-Avila M, Stampfer MJ, Ravnikar VA, et al. Caffeine and other predictors of bone density among pre- and perimenopausal women. Epidemiology ; 4 : — Hoover PA, Webber CE, Beaumont LF, et al. Postmenopausal bone mineral density: relationship to calcium intake, calcium absorption, residual estrogen, body composition, and physical activity.

Can J Physiol Pharmacol ; 74 : — Hegarty VM, May HM, Khaw KT. Tea drinking and bone mineral density in older women. Am J Clin Nutr ; 71 : —7. Johnell O, Gullberg B, Kanis JA, et al. Risk factors for hip fracture in European women: the MEDOS Study.

Mediterranean Osteoporosis Study. J Bone Miner Res ; 10 : — Wu CH, Yang YC, Yao WJ, et al. Epidemiological evidence of increased bone mineral density in habitual tea drinkers.

Arch Intern Med ; : —6. Kanis J, Johnell O, Gullberg B, et al. Risk factors for hip fracture in men from southern Europe: the MEDOS Study. Osteoporos Int ; 9 : 45 — Hakim IA, Harris RB, Weisgerber U.

Tea intake and skin squamous cell carcinoma: influence of type of tea beverages. Cancer Epidemiol Biomarkers Prev ; 9 : — Control Clin Trials ; 19 : 61 — Ware JE Jr, Sherbourne CD. The MOS item short-form health survey SF Europe and the Americas accounted for just over half of all these fractures, while most of the remainder were in the Western Pacific region and Southeast Asia.

Although usually affecting women more often than men, in China there is a higher incidence of hip fractures in men than women. Food Chem , , 57 16 , pp Publication Date Web : August 4, Article DOI: There is not one type of doctor that treats osteoporosis, as professionals of different medical disciplines can help manage the condition.

Learn more…. Osteoporosis is not a disability on its own, but chronic pain or recurring fractures can result in a disability qualification if they affect a….

There are many safe treatment options for people with osteoporosis. Bisphosphonate drugs can preserve bone strength and prevent fractures. Screening for osteoporosis is usually safe and painless. Various tests, including DEXA scans, take only a few minutes and provide valuable information.

My podcast changed me Can 'biological race' explain disparities in health? Why Parkinson's research is zooming in on the gut Tools General Health Drugs A-Z Health Hubs Health Tools Find a Doctor BMI Calculators and Charts Blood Pressure Chart: Ranges and Guide Breast Cancer: Self-Examination Guide Sleep Calculator Quizzes RA Myths vs Facts Type 2 Diabetes: Managing Blood Sugar Ankylosing Spondylitis Pain: Fact or Fiction Connect About Medical News Today Who We Are Our Editorial Process Content Integrity Conscious Language Newsletters Sign Up Follow Us.

Medical News Today. Health Conditions Health Products Discover Tools Connect. Green Tea May Benefit Bone Health. By Catharine Paddock, Ph. on September 17, Share this article. Latest news Ovarian tissue freezing may help delay, and even prevent menopause.

RSV vaccine errors in babies, pregnant people: Should you be worried? Scientists discover biological mechanism of hearing loss caused by loud noise — and find a way to prevent it.

How gastric bypass surgery can help with type 2 diabetes remission.