Have you ever reached for a can of soda only to hear someone say, “You know that’s bad for your bones?” Carbonation and high sugar content are often blamed for harming bone health, but is there evidence to support these claims?
As a biomedical scientist, I’ve learned that common health claims are often more complicated than they sound. As a Coca-Cola lover who also lives with a bone disease, I was especially curious to find out what the science actually says.
The short answer is that there may be a connection between drinking a lot of soda and poorer bone health, but it’s more complicated than soda simply “weakening” your bones.
What does the research show?
The standard way that scientists evaluate the health of your bones is by measuring bone mineral density (BMD), which reflects the amount of minerals packed into your bones.1Haseltine, K.N., Chukir T., Smith P.J., et al. Bone Mineral Density: Clinical Relevance and Quantitative Assessment. J Nucl Med, 2021. 62(4). https://pubmed.ncbi.nlm.nih.gov/33310738/
Lower BMD means bones contain fewer minerals and may be more susceptible to fractures.
Research has suggested a possible connection between soda consumption and bone health. Some studies have linked higher soda consumption to lower BMD, while others have found an association with an increased risk of bone fractures.2Ahn, H. and Park, Y.K. Sugar-sweetened beverage consumption and bone health: A systematic review and meta-analysis. Nutr J, 2021. 20(1). https://pubmed.ncbi.nlm.nih.gov/33952276/3Fung, T.T., Arasaratnam, M.H., Grodstein F., et al. Soda consumption and risk of hip fractures in postmenopausal women in the Nurses’ Health Study. Am J Clin Nutr, 2014. 100(3). https://pubmed.ncbi.nlm.nih.gov/25099544/4Kremer, P.A., Laughlin, G.A., Shadyab, A.H., et al. Association between soft drink consumption and osteoporotic fractures among postmenopausal women: The Women’s Health Initiative. Menopause, 2019. 26(11). https://pubmed.ncbi.nlm.nih.gov/31613830/
That may sound concerning, but an association does not prove that soda causes low BMD. It could be that people who drink a lot of soda have other factors in common, like diet, exercise habits, or other factors that affect their bones instead.
So, what might explain the connection? Let’s look at the two commonly blamed ingredients: carbonation and sugar.
Is carbonation the problem?
Simply put, probably not.
Some have suggested that carbonation could interfere with calcium, an essential mineral for strong bones. However, research doesn’t provide much evidence that the bubbles themselves are harmful.5Schoppen, S., Perez-Granados, A.M., Carbajal, A., et al. Bone remodelling is not affected by consumption of a sodium-rich carbonated mineral water in healthy postmenopausal women. Br J Nutr, 2005. 93(3). https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/bone-remodelling-is-not-affected-by-consumption-of-a-sodiumrich-carbonated-mineral-water-in-healthy-postmenopausal-women/197917F7DD10E91569C3FE64F79671516Kim, S.H., Morton, D.J., Barrett-Connor, E.L.. Carbonated beverage consumption and bone mineral density among older women: The Rancho Bernardo Study. Am J Public Health, 1997. 87(2). https://pmc.ncbi.nlm.nih.gov/articles/PMC1380807/
A 1997 study of 1,000 women found no association between carbonated beverage consumption and BMD.6Kim, S.H., Morton, D.J., Barrett-Connor, E.L.. Carbonated beverage consumption and bone mineral density among older women: The Rancho Bernardo Study. Am J Public Health, 1997. 87(2). https://pmc.ncbi.nlm.nih.gov/articles/PMC1380807/ After accounting for factors including age, calcium intake, exercise, smoking, alcohol, and hormone use, modest consumption of carbonated beverages did not negatively affect BMD.
The Framingham Osteoporosis Study, which included more than 2,500 adults, found that women who regularly drank cola had approximately 3.7% lower BMD at the femoral neck (the area near the top of the thigh bone) compared with women who rarely drank cola.7Tucker, K.L., Morita, K., Qiao, N., et al. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. Am J Clin Nutr, 2006. 84(4). https://pubmed.ncbi.nlm.nih.gov/17023723/ This association was not seen in men.
Interestingly, the researchers did not find lower BMD among women who drank non-cola carbonated beverages.7Tucker, K.L., Morita, K., Qiao, N., et al. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. Am J Clin Nutr, 2006. 84(4). https://pubmed.ncbi.nlm.nih.gov/17023723/ If carbonation were responsible, we might expect similar findings with other fizzy drinks.
Together, these findings suggest that carbonation probably doesn’t weaken bones.
Is high sugar content the problem?
Sugar may be part of the picture, but it probably isn’t the whole story.
In 2021, researchers analyzed the results of 26 studies involving more than 124,000 people. They found that adults who consumed more sugar sweetened beverages tended to have lower BMD in adults.2Ahn, H. and Park, Y.K. Sugar-sweetened beverage consumption and bone health: A systematic review and meta-analysis. Nutr J, 2021. 20(1). https://pubmed.ncbi.nlm.nih.gov/33952276/ Other research has also linked diets high in sugar with poorer bone health.8Tucker, K.L., Chen, H., Hannan, M.T., et al. Bone mineral density and dietary patterns in older adults: The Framingham Osteoporosis Study. Am J Clin Nutr, 2002. 76(1). https://pubmed.ncbi.nlm.nih.gov/12081842/9Boushey, C., Ard, J., Bazzano, L., et al. Dietary Patterns and Bone Health: A Systematic Review. USDA Nutrition Evidence Systematic Review, 2020. https://pubmed.ncbi.nlm.nih.gov/35129903/
One explanation is that sugary beverages may replace more nutrient-rich options. For example, a study of young children found that those who consumed more sweetened beverages tended to drink less milk and consume less calcium, which is essential for maintaining strong bones.10Keller, K.L., Kirzner, J., Pietrobelli, A., et al. Increased sweetened beverage intake is associated with reduced milk and calcium intake in 3- to 7-year-old children at multi-item laboratory lunches. J Am Diet Assoc, 2009. 109(3). https://pmc.ncbi.nlm.nih.gov/articles/PMC2748414/
High sugar intake may also affect how the body handles calcium, vitamin D, and other minerals involved in bone health, although its direct contribution to poorer bone health remains unclear.11Tsanzi, E., Fitch, C.W., Tou, J.C.. Effect of consuming different caloric sweeteners on bone health and possible mechanisms. Nutr Rev, 2008. 66(6). https://pubmed.ncbi.nlm.nih.gov/18522618/
What about diet sodas? Researchers have investigated whether sugar substitutes, such as aspartame, affect bone health. The Framingham Osteoporosis Study found that both regular and diet cola consumption was associated with lower BMD in women.7Tucker, K.L., Morita, K., Qiao, N., et al. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. Am J Clin Nutr, 2006. 84(4). https://pubmed.ncbi.nlm.nih.gov/17023723/ Similarly, in one six-month study, participants who drank regular or artificially sweetened cola experienced similarly small decreases in bone mass, with no statistically significant difference between the two groups.12Maersk, M., Belza, A., Stødkilde-Jørgensen, H., et al. Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: A 6-mo randomized intervention study. Am J Clin Nutr, 2012. 95(2). https://pubmed.ncbi.nlm.nih.gov/22205311/ Overall, there is not yet sufficient evidence to determine the effects of artificial sweeteners on bone health.13Xu, X., Wang, Q., Li, B., et al. Effects of Artificial Sweeteners on the Musculoskeletal System: A Systematic Review of Current Evidence. Nutrients, 2025. 17(21). https://pubmed.ncbi.nlm.nih.gov/41228560/
If we can’t fully blame carbonation or sugar, then why might soda be associated with poorer bone health?
There isn’t one simple explanation. Researchers have investigated several other possibilities, including phosphoric acid, caffeine, and what soda replaces in the diet.
Phosphoric acid, commonly found in cola, has received particular attention. Researchers have suggested that consuming a lot of phosphorus relative to calcium could affect mineral balance and affect bone health.14Calvo, M.S.. Dietary phosphorus, calcium metabolism and bone. J Nutr, 1993. 123(9). https://pubmed.ncbi.nlm.nih.gov/8360792/ However, studies have not established that phosphoric acid in cola directly harms bone health, and one small study found that phosphoric acid in carbonated beverages did not significantly increase calcium loss in urine.15Heaney, R.P., Rafferty, K.. Carbonated beverages and urinary calcium excretion. Am J Clin Nutr, 2001. 74(3). https://pubmed.ncbi.nlm.nih.gov/11522558/
Caffeine may also play a role. Caffeine can temporarily increase calcium lost through urine, which may matter more when calcium intake is low.15Heaney, R.P., Rafferty, K.. Carbonated beverages and urinary calcium excretion. Am J Clin Nutr, 2001. 74(3). https://pubmed.ncbi.nlm.nih.gov/11522558/ However, caffeine can’t fully explain the association between soda and BMD either. The Framingham Osteoporosis Study found that decaffeinated cola was also associated with lower BMD in women, although the relationship was weaker than with caffeinated cola.7Tucker, K.L., Morita, K., Qiao, N., et al. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. Am J Clin Nutr, 2006. 84(4). https://pubmed.ncbi.nlm.nih.gov/17023723/ Beyond its effect on calcium balance, caffeine can also interfere with sleep, and some studies have suggested a relationship between poor sleep and lower BMD.16Drake, C., Roehrs, T., Shambroom, J., et al. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. J Clin Sleep Med, 2013. 9(11). https://pubmed.ncbi.nlm.nih.gov/24235903/17Tian, J., Zhang, J., Ding, L., et al. Association Between Sleep Duration and Low Bone Mineral Density and Osteoporosis: A Systematic Review and Meta-Analysis. Calcif Tissue Int, 2024. 116(1). https://pubmed.ncbi.nlm.nih.gov/39673612/ However, whether drinking caffeinated soda directly causes bone loss remains unclear.
Another explanation may have less to do with what is in soda and more to do with what soda replaces. Frequently choosing soda may mean consuming fewer calcium-rich foods and drinks. This is particularly important during childhood and adolescence, when the body is building much of the bone mass it will carry into adulthood.18Chevalley, T., Rizzoli, R.. Acquisition of peak bone mass. Best Pract Res Clin Endocrinol Metab, 2022. 36(2). https://pubmed.ncbi.nlm.nih.gov/35125324/
Ultimately, no single ingredient fully explains the relationship between soda and bone health. Calcium and vitamin D intake, physical activity, age, smoking, and alcohol consumption also influence bone health.19Wilson-Barnes, S.L., Lanham-New, S.A., Lambert, H.. Modifiable risk factors for bone health & fragility fractures. Best Pract Res Clin Rheumatol, 2022. 36(3). https://pubmed.ncbi.nlm.nih.gov/35750569/20NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA, 2001. 285(6). https://pubmed.ncbi.nlm.nih.gov/11176917/
So, do you need to give up soda for healthy bones?
Probably not. The occasional soda is unlikely to make or break your bone health.
Research does suggest an association between frequent soda consumption, particularly cola and sugar-sweetened beverages, and poorer bone health in some populations, but that does not prove that soda directly weakens bones.2Ahn, H. and Park, Y.K. Sugar-sweetened beverage consumption and bone health: A systematic review and meta-analysis. Nutr J, 2021. 20(1). https://pubmed.ncbi.nlm.nih.gov/33952276/7Tucker, K.L., Morita, K., Qiao, N., et al. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. Am J Clin Nutr, 2006. 84(4). https://pubmed.ncbi.nlm.nih.gov/17023723/
Rather than avoiding the occasional soda, you will likely make a much bigger impact on your bone health by focusing on the bigger picture of habits that maintain healthy bones: get enough calcium and vitamin D, eat a well-balanced diet, stay physically active, and make sure soda isn’t regularly replacing nutrient-rich foods and drinks.21Rizzoli, R., Biver, E., Brennan-Speranza, T.C.. Nutritional intake and bone health. Lancet Diabetes Endocrinol, 2021. 9(9). https://pubmed.ncbi.nlm.nih.gov/34242583/22Christianson, M.S., Shen, W.. Osteoporosis prevention and management: Nonpharmacologic and lifestyle options. Clin Obstet Gynecol, 2013. 56(4). https://pubmed.ncbi.nlm.nih.gov/24047936/ Of course, bone health isn’t the only consideration. Regularly drinking sugary soda has also been linked to other health concerns, including increased risk of type 2 diabetes and tooth decay, making it important to be mindful of how much soda you consume.23Malik, V.S., Popkin, B.M., Bray, G.A., et al. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: A meta-analysis. Diabetes Care, 2010. 33(11). https://pubmed.ncbi.nlm.nih.gov/20693348/24Moynihan, P.J., Kelly, S.A.. Effect on caries of restricting sugars intake: Systematic review to inform WHO guidelines. J Dent Res, 2014. 93(1). https://pubmed.ncbi.nlm.nih.gov/24323509/
The bottom line? Don’t blame the bubbles, and keep the sugar in moderation!
