Alcohol: A Simple Nutrient with Complex Actions on Bone in the Adult Skeleton

Abstract

Background Alcohol is an important nonessential component of diet, but the overall impact of drinking on bone health, especially at moderate levels, is not well understood. Bone health is important because fractures greatly reduce quality of life and are a major cause of morbidity and mortality in the elderly. Regular alcohol consumption is most common following skeletal maturity, emphasizing the importance of understanding the skeletal consequences of drinking in adults. Method This review focuses on describing the complex effects of alcohol on the adult skeleton. Studies assessing the effects of alcohol on bone in adult humans as well as skeletally-mature animal models published since the year 2000 are emphasized. Results Light to moderate alcohol consumption is generally reported to be beneficial, resulting in higher bone mineral density (BMD) and reduced age-related bone loss, whereas heavy alcohol consumption is generally associated with decreased BMD, impaired bone quality and increased fracture risk. Bone remodeling is the principle mechanism for maintaining a healthy skeleton in adults and dysfunction in bone remodeling can lead to bone loss and/or decreased bone quality. Light to moderate alcohol may exert beneficial effects in older individuals by slowing the rate of bone remodeling but the impact of light to moderate alcohol on bone remodeling in younger individuals is less certain. The specific effects of alcohol on bone remodeling in heavy drinkers is even less certain because the effects are often obscured by unhealthy lifestyle choices, alcohol-associated disease, and altered endocrine signaling. Conclusions Although there have been advances in understanding the complex actions of alcohol on bone, much remains to be determined. Limited evidence implicates age, skeletal site evaluated, duration and pattern of drinking as important variables. Few studies systematically evaluating the impact of these factors have been conducted and should be made a priority for future research. In addition, studies performed in skeletally mature animals have potential to reveal mechanistic insights into the precise actions of alcohol and associated co-morbidity factors on bone remodeling.

The association between alcohol consumption and risk of hip fracture differs by age and gender in Cohort of Norway: a NOREPOS study

“…Neither our study nor the Framingham study found a corresponding association in older men. One possible explanation could be that light to moderate alcohol consumption may affect bone beneficially in older individuals by slowing the rate of bone remodelling, while this effect is less certain in younger individuals [14]. Another possible explanation for the lack of an association in older men is selection bias, since a higher proportion of older heavy drinkers could have died before they reached the high-risk age for hip fracture, or they might have refrained from participating in the CONOR-studies because of poor health or comorbidities.…”

“…Alcoholism is a well-established risk factor for hip fractures because of increased risk of falling, poor nutritional status, poor functional status, more co-morbidities, disturbances in the bone remodelling system, impaired bone quality and adverse endocrine changes [10][11][12][13][14].…”

“…Light to moderate alcohol consumption has been associated with higher bone mineral density (BMD) and reduced age-related bone loss [14]. However, much remains to be determined in understanding the complex influence of alcohol on bone health.…”

“…However, much remains to be determined in understanding the complex influence of alcohol on bone health. There is, for example, limited knowledge regarding potential differences in associations by age and gender [14].…”

When an enemy becomes a friend. On the benefits of alcohol consumption

“…Результаты большинства исследований указывают на увеличение под влиянием умеренных доз алкоголя мине-ральной плотности костей и снижение риска переломов, обусловленных остеопорозом [72][73][74]. Marrone et al изу-чали здоровых женщин в постменопаузе, употреблявших 19 ± 1 г этанола в день.…”