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During the past decades, the incidence of osteoporotic fractures has increased dramatically in the Western world. Consumption of coffee and intake of caffeine have in some studies been found to be associated with increased risk of osteoporotic fractures, but overall results from previous research are inconsistent. Despite weak evidence, some osteoporosis organisations recommend limiting daily coffee or caffeine intake.

The primary aim of this thesis was to study the association between long-term consumption of coffee and bone mineral density (BMD), incidence of osteoporosis and fractures. A secondary aim was to study the relation between tea consumption and fracture risk.

An increased risk of osteoporotic fractures in individuals who consumed ≥ 4 cups of coffee vs < 1 cup coffee per day was demonstrated in a study of 31,257 Swedish middle-aged and elderly women (a part of the Swedish Mammography Cohort - SMC) when calcium intake was low (< 700 mg/day). However, no higher risks of osteoporosis or fractures were observed in the full SMC with increasing coffee consumption. In the full SMC (n = 61,433) the follow-up was longer and the number of fractures was higher. Similarly, no statistically significant associations between consumption of coffee (≥ 4 cups of coffee vs < 1 cup) and incidence of osteoporotic fractures were observed in the Cohort of Swedish Men (COSM), including 45,339 men. Calcium intake did not modify the results from the investigations performed in the full SMC or COSM.

Nonetheless, a 2 - 4% lower BMD at measured sites was observed in men participating in the PIVUS cohort and in women from a sub-cohort of the SMC who consumed ≥ 4 cups of coffee vs < 1 cup daily. Individuals with high coffee intake and rapid metabolism of caffeine had lower BMD at the femoral neck.

No association between tea consumption and risk of fractures was found in the studies.

In conclusion, the findings presented in this thesis demonstrate that high consumption of coffee may be associated with a modest decrease in BMD. However, there was no evidence of a substantially increased incidence of osteoporosis or fractures typically associated with osteoporosis.