Osteoporosis International · Nov 4, 2026

Impact of sugar- and artificially sweetened beverages on bone health: a systematic review, meta-analysis, and network meta-analysis among children, adolescents, and adults

By Cadeau Comte N, Couto Alfonso S, Cuenca-Zaldivar JN et al.

Context Sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB) may affect bone health. Previous systematic reviews and meta-analyses have examined specific associations, particularly between SSB consumption and bone mineral density (BMD); however, a comprehensive synthesis comparing different SSB and ASB categories across multiple bone health outcomes and age groups is lacking. Objective To summarize the available literature on the association between SSB and ASB consumption and bone health in children, adolescents, and adults, and to compare different beverage categories through meta-analysis and network meta-analysis. Design Systematic review, meta-analysis, and network meta-analysis. Data sources PubMed, Scopus, and ScienceDirect from inception to August 2025. Data extraction Five reviewers screened 954 records against the eligibility criteria, and the extracted data were independently cross-checked. Quantitative synthesis used a frequentist random-effects framework, including dose-response multilevel network meta-analysis (NMA), to compare beverage categories and consumption frequencies across bone health outcomes. Study quality and risk of bias were assessed using the NIH/NHLBI Quality Assessment Tools. Data analysis Forty-one studies met the inclusion criteria, and 27 contributed to the quantitative synthesis. No beverage category was significantly associated with BMD; for carbonated cola/non-cola beverages, β = −0.653 (95% CI − 1.310 to 0.004). Relative to occasional/non-consumers, higher fracture-risk estimates were observed for carbonated cola/non-cola beverages [log odds ratio (LOR) = 0.442 (95% CI 0.184 to 0.699)], caffeinated carbonated cola/non-cola beverages [LOR = 0.406 (95% CI 0.147 to 0.666)], non-caffeinated carbonated cola/non-cola beverages [LOR = 0.452 (95% CI 0.205 to 0.699)], and sugar-sweetened carbonated beverages/packaged juices [LOR = 0.349 (95% CI 0.256 to 0.376)]. For osteoporosis/osteopenia, higher estimates were observed for carbonated cola [LOR = 1.017 (95% CI 0.876–1.158)] and carbonated cola/non-cola beverages [LOR = 0.792 (95% CI 0.731–0.852)]. Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty was very low for all three primary outcomes. Conclusions Selected comparisons involving higher SSB consumption, particularly cola-type beverages, were associated with higher fracture and osteoporosis/osteopenia estimates, whereas no beverage category was significantly associated with BMD. However, these observational associations do not establish causality. Certainty was very low for all primary outcomes, and the evidence regarding ASB was insufficient to support firm conclusions. Systematic review registration The review was registered in PROSPERO (CRD42020171873); subsequent amendments and protocol deviations are described in the Methods section.

doi.org/10.1007/s00198-026-08264-3PubMed 42980778Populations