Regular cups of tea or coffee, and beefing up protein intake could help women reduce their risk of suffering a hip fracture, say scientists, who found that a daily 25g increase in protein was associated with, on average, a 14% reduction in women’s risk of hip fracture. In a surprise twist, they also discovered that every additional cup of tea or coffee they drank was linked to a 4% reduction in risk.
The study by food scientists at the University of Leeds in the UK was published in the journal Clinical Nutrition, the researchers noting that the protective benefits were greater for underweight women, with a 25g/day increase in protein reducing their risk by 45%.
The protein could come in any form: meat, dairy or eggs; and for people on a plant-based diet, from beans, nuts or legumes. Three to four eggs would provide around 25g of protein as would a steak or piece of salmon, while 100g of tofu would provide about 17g of protein.
Slightly more than 3% of the women in the study group experienced a hip fracture.
Observational study
The investigation was based on a large observational analysis of more than 26 000 women. The researchers were able to identify associations between factors in diet and health, and could not single out direct cause and effect.
James Webster, a doctoral researcher in the School of Food Science and Nutrition at Leeds who led the study, said: “Across the world, the costs to individuals and societies caused by hip fracture are enormous.
“This can often lead to other chronic illnesses, loss of independence, and premature death. In the UK, the annual cost to the NHS is between £2bn and £3bn.
“Diet is a factor that people can modify to protect themselves by maintaining healthy bones and muscles. This study is one of the first to investigate relationships between food and nutrient intakes and risk of hip fracture, with hip fractures accurately identified through hospital records.
“The results highlight which aspects of diet may be useful tools in reducing hip fracture risk in women, with evidence of links between higher protein, tea and coffee intakes and a reduced risk.”
Proteins are the basic building blocks of life and are needed to keep cells, tissues and muscles working properly as well as contributing to bone health.
The recommended protein intake in the UK is 0.8g per kilogram of bodyweight per day, a limit some nutritional experts believe is too low. As the study revealed, people who had a higher protein consumption had a reduction in the risk of hip fracture. However, intakes of protein which are very high – where intake is greater than 2g to 3g of protein/kg body weight/day – can have negative health effects. The study was not able to explore these very high protein intake levels.
Professor Janet Cade, who leads the Nutritional Epidemiology Group at Leeds and supervised the research, said: “In the UK most people eat an adequate amount of protein, however, certain groups, like vegetarians or vegans, need to check that their protein intakes are high enough for good health.”
Why underweight women may see greater risk reductions
Women who are underweight may be more likely to have reduced bone mineral density and muscle mass. Increasing intakes of several foods and nutrients, especially protein, may help reduce their hip fracture risk more than in healthy or overweight women by helping to establish or restore bone and muscle health.
However, the researchers say this finding needs further research to confirm this.
Tea and coffee both contain biologically active compounds called polyphenols and phytoestrogens, which may help to maintain bone health.
Of the 26 318 women involved in the study, 822 cases of hip fracture were identified, that is 3.1%.
Study details
Foods, nutrients and hip fracture risk: A prospective study of middle-aged women.
James Webster, Darren Greenwood, Janet Cade.
Published in Clinical Nutrition on 1 December 2022
Summary
Background and aims
Hip fracture affects 1.6m people globally each year, and increases morbidity and mortality. There is potential for risk reduction through diet modification, but prospective evidence for associations between intake of several foods and nutrients and hip fracture risk is limited. This study aimed to investigate associations between food and nutrient intakes and hip fracture risk in the UK Women’s Cohort Study, and to determine the role of body mass index (BMI) as a potential effect modifier.
Methods
Dietary, lifestyle, anthropometric, and socio-economic information of UK women, ages 35–69 years, were collected in a survey at recruitment (1995–1998), and included a validated 217-item food frequency questionnaire. Hip fracture cases were identified by linking participant data at recruitment with their Hospital Episode Statistics (HES) up to March 2019. Cox regression models were used to estimate associations between standard portions of food and nutrient intakes and hip fracture risk over a median follow-up time of 22.3 years.
Results
Among 26 318 women linked to HES data (556,331 person-years), 822 hip fracture cases were identified. After adjustment for confounders, every additional cup of tea or coffee per day was associated with a 4% lower risk of hip fracture (HR (95% CI): 0.96 (0.92, 1.00)). A 25 g/day increment of dietary protein intake was also associated with a 14% lower risk of hip fracture (0.86 (0.73, 1.00)). In subgroup analyses, BMI modified linear associations between dietary intakes of protein, calcium, total dairy, milk, and tea and hip fracture risk (pinteraction = 0.02, 0.002, 0.003, 0.001, and 0.003, respectively); these foods and nutrients were associated with a reduced risk of hip fracture in underweight but not healthy or overweight participants. In particular, risk of hip fracture in underweight participants (28 cases, 545 participants) was 45% lower for every 25 g/day protein consumed (0.55 (0.38, 0.78)).
Conclusions
This is the first prospective cohort study internationally of multiple food and nutrient intakes in relation to hip fracture risk by BMI using linkage to hospital records. Results suggest that the potential roles of some foods and nutrients in hip fracture prevention, particularly protein, tea and coffee in underweight women, merit confirmation.
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