Association between coffee consumption and the risk of developing osteoporosis: a meta-analysis

Osteoporosis is a skeletal disorder characterized by reduced bone mineral density and deterioration of bone microarchitecture, posing a significant health care burden, particularly among elderly individuals. Coffee contains various bioactive compounds, such as caffeine, which may have multifaceted effects on bone metabolism. However, epidemiological studies have reported inconsistent findings regarding the relationship between habitual coffee consumption and the risk of osteoporosis. We conducted this meta-analysis to synthesize existing evidence on the association between coffee and osteoporosis systematically, thereby addressing the methodological heterogeneity and conflicting findings across previous studies. A comprehensive systematic literature search was conducted in PubMed, EMBASE, the Cochrane Library, and Web of Science, covering records up to December 31, 2025. Observational studies that quantified coffee consumption and reported osteoporosis incidence were considered eligible. The search and reporting processes strictly followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) statement. The methodological quality of the included studies was evaluated using established tools appropriate for each study design: cross-sectional studies were assessed with the Agency for Healthcare Research and Quality (AHRQ) tool, whereas cohort and case–control studies were evaluated using the Newcastle–Ottawa Scale (NOS). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using both fixed-effect and random-effects models. Heterogeneity across studies was quantified with the I 2 statistic, and publication bias was assessed accordingly. Eighteen independent studies (with 588,766 participants) met the inclusion criteria. The results of the pooled analysis revealed an inverse dose-dependent correlation between coffee consumption and composite osteoporosis risk (ORs = 0.79, 95% CI [0.72, 0.87], P < 0.001), although this correlation was accompanied by considerable heterogeneity (I 2 = 75%). Hierarchical analysis revealed no statistically significant association between postmenopausal women’s exposure and osteoporosis risk (combined ORs = 0.91, 95% CI [0.73, 1.13], Z = 0.08; P = 0.38). Our analysis revealed that moderate coffee consumption may be inversely associated with the risk of osteoporosis. However, substantial heterogeneity across studies highlights the need for further standardized and rigorous research to establish causality, to identify the optimal intake level, and to clarify the underlying mechanisms in diverse populations.