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Phosphorus, and Bone Density: What’s the Link?

Michelle Eckland

October 5, 2009




        Throughout my childhood, I learned from my parents that in order to have strong bones, I needed to drink milk. I never knew that phosphorus was a mineral that also played a critical role in bone density.  Bone density and bone mass two terms that are often used interchangeably to describe the amount of mineral in a bone. ( ) I learned that an individual’s bone density is the result of the ratio between phosphorus and calcium. The ratio between a high phosphorus, low calcium consumption leads to a lower bone density. The shift towards a more convenience based lifestyle has led to an unbalanced consumption of phosphorus. I was curious to see if the increase in phosphorus consumption in American diets is contributing to lower bone density and the increased likelihood of fractures.


The Role Phosphorus Plays in Bone Development 

        About 85% of phosphorus in the body can be found in the bones and teeth. Phosphorus helps filter out waste in the kidneys and contributes to energy production in the body by participating in the breakdown of carbohydrates, proteins, and fats. ( ) The Institute of Medicine (Sax 2001) states that if calcium consumption does not keep pace with phosphorus consumption, then there will be a release of calcium from the bone via bone resorption, which will normalize the concentration of calcium in the blood at the expense of one’s bone density. Subsequently when a person consumes too much or too little calcium in relation to phosphorus, their bone density will decrease. The amount of phosphorus that Americans are consuming has been on the rise. ( )


Recommended Daily Allowance of Phosphorus (RDA)



0-6 months


7-12 months


1-3 years


4-8 years


9-18 years


19 + years







Dietary Sources of Phosphorus



Amount of Phosphorus

Cola (8oz)


Milk (1 cup)


Ground Beef (3oz)


Tofu (1cup)

120 mg

Peanut Butter (2tbsp)


Cheddar Cheese (1oz)


Kidney Beans (1/2cup)


Cereal (1cup)



How Has Cola Consumption Changed?     

        The consumption of carbonated beverages has significantly increased over the years. In 1942, the average person consumed 90 8oz servings (5.6 gallons) of carbonated cola beverages a year (Vartanian, Schwartz, & Brownell, 2007). The average teenager now drinks 65 gallons of carbonated cola beverages a year. Between 1970 and 1997 per capital consumption of carbonated soft drinks increased 118% while consumption of milk declined 23% (Sax, 2001). Is it the increased intake of phosphorus through cola carbonated beverages, the decreased intake in the consumption of milk, or a combination of the two factors that are resulting in lower bone densities among Americans.?




Are Carbonated Beverages Contributing to Bone Loss?

        Wyshak (2000)  conducted a study to determine the possible association between the consumption of carbonated beverages and bone fractures among teenaged girls. The participants in the study consisted of 460 high school females about half of whom participated in some type of sports activity. The females completed a questionnaire reporting their personal and behavioral practices and their physical activities. The students were asked if they consumed non-cola carbonated beverages, cola carbonated beverages, both non-cola and cola carbonated beverages, or neither. In order to analyze the data, researchers looked at the consumption of the various beverages in relation to physical activity and incidence of bone fractures. The study found that for less active girls there was a limited association between carbonated cola beverages and bone fractures. However, active teenagers who drank cola beverages had a fracture risk 4.94 times higher than the active girls who denied drinking cola beverages.

          There were a couple limitations within the study. The sample population was relatively small and was representative of only one high school; therefore the explicability and validity of the study is in question. Furthermore, the questionnaire did not include questions on calcium consumption. As a result, researchers do not know if the females were not meeting the RDA for calcium, which could also contribute to incidence of fractures. Subsequently, the study cannot claim that the consumption of carbonated beverages in active females is the sole factor for their increased likelihood of fractures. Even though there are some limitations within the study; it appears that there is something in cola that can be attributed to the decreased bone density in females; however, the research is not substantial.





        Tucker, Morita, Qiao, Hannan, Cupples, & Kriel (2006),  also looked at the association between carbonated beverages and bone mineral density; however, their study was more in depth than Wyshak‘s (2000). The study examined associations with by cola subtype: sweetened, diet, caffeinated, decaffeinated. The participants in the study were 1413 women and 1125 men. Dietary intake was assessed by a food-frequency questionnaire. The study found that for men who consumed on average five cans of cola a week, there were no significant associations between BMD and cola intake. For women who consumed an average of four cans of cola a week, all of the cola subgroups With the all of the cola subgroups (sugared, caffeinated, diet) with the exception of the sugared decaffeinated colas, showed lower BMD. However, one of the benefits of the study is that it adjusted for confounding variables; age, BMI, height, smoking, average daily intakes of alcohol, calcium, caffeine; total energy intake, physical activity, and in women estrogen use and menopause use. Therefore, after adjusting for the confounding variables including calcium, the the data supports the notion that there is something within the cola that is contributing to bone density. Previous research on the effects of cola on BMD in women have tried to claim that the disparity is a result of inadequate calcium intake. However, in this study there was no difference in milk consumption by level of cola intake; therefore, challenging the belief that cola drinkers have lower BMD because they do not consume the same amount of milk.



        Fish Fillet                                     chicken patty                               Aunt Jemima


Alternative Ideas, Is Bone Density The Result Of The Food We Eat?

        Spencer, Kramer, and Osis (1988) note that an increase in phosphorus consumption is nearly inevitable in the American diet. Calvo and Park (1996) found that the use of phosphorus containing additives has increased about 17% over the last decade. However, this information was gathered in 1996 and I expect that it is outdated. Phosphorus can be used to preserve moisture and color within foods; subsequently, most fast food chains and frozen entrees use phosphate compounds in their products (Spencer et., al 1988). As a result of the fast paced American lifestyle and the increased demand for convenience foods, it is easier to obtain phosphorus. Therefore, nowadays with the variety of ways in which one can consume phosphorus, it takes less effort to meet the RDA requirement. On the other hand, Americans mainly consume calcium through dairy or calcium fortified products which makes it harder to reach the calcium RDA. As a result, the phosphorus to calcium ratio becomes more unbalanced.



          When conducting my research, it was hard to obtain information on diverse populations. The majority of the research consisted of small sample sizes with targeted populations. Most of the studies actually took place in New England. Furthermore, there was no data presented on the effect of carbonated beverages or phosphorus intake on the bone density of children. I think that it would be of particular interest to conduct a longitudinal study on the bone development of children. It would be interesting to observe the differences in cola consumption in regards to their bone development throughout childhood and adolescence.



        There is controversy regarding the effects, if any cola has on bone density. The research I obtained found that the associations between cola intake and bone mineral density were only found in females. The data did not find a specific relationship between milk consumption and phosphorus intake; however, increased phosphorus intake was correlated with a decreased overall calcium intake. Further research needs to be conducted on the correlation between phosphorus, calcium, and bone density.

          In general, Americans do not have an accurate idea about the amount of phosphorus they are consuming. In order to achieve maximum bone density, an increase in phosphorus requires an increased intake in calcium consumption. If the discrepancy between calcium and phosphors consumption increases, then there will be a continuous decline in bone density.



                I first heard of phosphorus having an effect on bone density in nutrition class. I was interested in seeing if there was research to back up the claim. I believe that the increase in the consumption of carbonated cola beverages has contributed to individuals having lower bone densities. Furthermore, I believe that the likelihood in the decline of bone density in females as opposed to males can be attributed to differences in bone structure, stature size, and hormones. As a result of my research, I have learned that I should probably work on my obsession with cherry coke zero. 



cherry coke zero




Calvo, M., & Park, Y. (1996). Changing Phosphorus Content of the U.S. Diet: Potential   for Adverse Effects on Bone. American Institute of Nutrition, 126, 1168-1180.


Heaney, R., & Nordin, B. (2002). Calcium Effects on Phosphorus Absorption:         Implications for the Prevention and Co-Therapy of Osteoporosis. Journal of the         American College of Nutrition, 21(3), 239-244.


Sax, L. (2001). The Institute of Medicine’s “Dietary Reference Intake” for Phosphorus: A         Critical Perspective. Journal of the American College of Nutrition 20 (4), 271-        278.


Spencer, H., Kramer, L., & Osis.D. (1988). Do Protein and Phosphorus Cause Calcium         Loss? American Institute of Nutrition, 118, 657-660.


Tucker, K., Morita, K., Qiao, N., Hannan, M., Cupples, A., & Kiel, D. (2006). Colas, but Not Other Carbonated Beverages Are Associated With Low Bone Mineral   Density in Older Women: The Framingham Osteoporosis Study. American Society for Nutrition, 84, 936-942.


Vartanian, L., Schwartz, M., & Brownell, K. (2007) Effects of Soft Drink Consumption    on Nutrition and Health: A Systematic Review and Meta-Analysis. American      Journal of Public Health, 97(4) 667-675.


Wyshak, G. (2000). Teenaged Girls, Carbonated Beverage Consumption, and Bone         Fractures. Adolescent Medicine, 154, 610-613.




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