常喝咖啡，会影响骨密度吗？

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从目前证据来看，可能只有人群中最高水平的咖啡因摄入量才会对骨密度和骨折风险产生不利影响；

具体研究数据来看，每天咖啡因不超过400毫克，不会对骨骼造成不良影响。

首先，机制方面的研究发现，咖啡因并非一味地作用于降低骨密度的方向，而是两方面都有。我们知道，咖啡因通过抑制腺苷受体来让人保持清醒，而腺苷受体们也在骨调节方面起不同的作用，理论上看，咖啡因阻断腺苷受体A1可能增加骨密度，而阻断腺苷受体A2却促骨质疏松，要看这两股相反的力量最终哪个占上风 [17]。

至于增加钙排泄方面，有研究者指出，咖啡促进的那些排泄量在临床上没有意义，或者吃点乳制品就很容易补补回来了，除非因为喝咖啡而不喝牛奶了 [17]。

看实际的研究证据的话：支持“喝咖啡增加骨折风险”的是2006-2015年的多项针对瑞典女性的观察性研究 [18-20]，比如针对31527名年龄在40岁至76岁之间的瑞典女性的前瞻性研究中，发现每天摄入330mg咖啡因与骨折风险增加有关，但增加幅度不大；对60000多名平均年龄54岁的瑞典女性进行的20年观察发现，每天至少喝4杯（150ml一杯）咖啡与股骨颈（femoral neck）骨密度降低有关，但达不到易骨折的程度。

结合这些数据，可能只有人群中最高水平的咖啡因摄入量才会对骨密度和骨折风险产生不利影响，比如有的研究者经过归纳认为，每天咖啡因不超过400毫克，不会对骨骼造成不良影响 [21]。

不支持

“喝咖啡增加骨折风险”

的研究：

同时，不支持“喝咖啡增加骨折风险”的研究也有不少。

对1761名韩国绝经前前女性的研究，没观察到咖啡摄入量与股骨颈或腰椎骨密度之间存在显著关系[22]。

那对于已经绝经的女性呢？另一项针对韩国平均年龄为66岁的绝经后女性的研究中，相比于不喝咖啡，那些每天喝一次以上咖啡的人，患骨质疏松症的风险反而要低，腰椎和股骨颈的骨密度也更高。研究的作者认为，咖啡的雌激素样作用、抗氧化和抗炎作用可能是这种正面作用的原因 [23-24]。

土耳其一项对200名绝经后女性进行的相对较小的队列研究，也发现咖啡因与骨密度之间没有显著关联 [25]。

还有一项比较近的香港研究对当地564名健康成年人进行了为期10年的评估，发现习惯性喝咖啡的人反而腰椎和股骨颈骨密度高。通过血液检测，发现三种咖啡代谢产物（5-乙酰氨基-6-甲酰氨基-3-甲基尿嘧啶、3-羟基马齿苋和胡芦巴碱）的存在与骨密度增加有关 [26]。

总而言之，目前来看，每天摄入咖啡因不超过400mg，而且钙摄入充足的人，不用担心咖啡降低骨密度或者增加骨折风险。

400mg咖啡因换算成市售咖啡是多少呢？

前段时间深圳消协测了市面上常见的12个品牌店出售的现制咖啡，冰美式一杯的咖啡因含量大概在 136 到227mg，不超过400mg也就是别超过2杯；冰拿铁一杯的咖啡因含量大概在 66 到 186mg，也就是说一天别超过3杯，具体数据看这一篇→咖啡店的美式/拿铁一杯有多少咖啡因？他们帮你测了一下

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