This discussion considers current knowledge about possible links between alcohol consumption and the development of osteoporosis. It looks at osteoporosis risk factors, focusing particularly on the possible association between alcohol consumption and the development of the condition.
The article draws on current professional and research literature. It seeks to provide general information rather than advice. If you, or someone you know is seeking advice or support regarding osteoporosis, please reach out to us directly.
The importance of strong, healthy bones
Bones have many roles in our body. Strong, flexible bones are important because:
- Bones provide a framework that gives shape and structure to our bodies, enabling us to move and function. For example, the large bones of our lower limbs support our trunk when we stand and move about.
- Bones protect our soft organs from injury. Ribs form a cage that protects our heart and lungs while the skull protects our brain.
- Bones store calcium which is released into the bloodstream when it’s needed by other parts of the body.
- Bones provide marrow for the development of blood cells.
The Process of Developing Bone Health
Bones are made mostly of collagen, a protein that provides the framework, and calcium, a mineral that adds strength and hardness to the bones in the framework. Bones containing higher amounts of these minerals are denser, stronger, more flexible and less likely to break.
Bone development, or bone modelling, occurs through a lifelong process called bone resorption. This involves the breaking down of old or damaged bone, which is replaced with new, stronger bone. The amount of bone that is broken down and rebuilt varies as we age.
During childhood and adolescence bones grow rapidly, becoming larger, heavier, and denser. More bone is made than is broken down. This enables bones to grow and increase in mass and strength.
In younger, healthier adults, similar amounts of bone are removed and replaced. At approximately age 35, people reach their peak bone mass. This is the point at which the bones reach their maximum strength and density. Achieving this peak enables the bones to store the calcium the body may need throughout life.
In older adults bone mass (also referred to as bone mineral density) begins to decrease. Bones may become brittle and susceptible to fractures and breaks. Low bone mass is not, in itself, a disease. However if bone loss continues, there is a risk of developing osteoporosis.
Osteoporosis
Osteoporosis is a condition that weakens bones. It occurs when new bone development doesn’t keep pace with the loss of old bone. This can result in bones becoming weaker, brittle, and increasingly susceptible to breaks and fractures. Osteoporosis is indicated by low bone mass which is measured by a bone mineral density (BMD) test. Males tend to lose bone mass more slowly than females. However, by age 65–70 years, males and females lose it at the same rate.
Osteoporosis often develops slowly over many years without any symptoms. People with osteoporosis may not know they have it until one of their bones breaks. Breaks due to osteoporosis generally occur in the hip, spine or wrist.
The prevalence of osteoporosis is quite high. It is the major cause of fractures in postmenopausal women and older men. A 2014 study measuring bone density estimated the prevalence of osteoporosis among those aged 50 and over to be 23% of women and 6% of men (Australian Institute of Health, 2014).
Osteoporosis Risk factors
There are a number of factors that can contribute to the development of osteoporosis. Some cannot be changed but others may be managed through changes in lifestyle factors.
Factors which cannot be changed include
- Female: Women are more likely to develop osteoporosis
- Age: Older people are more likely to have osteoporosis
- Small body structure: slender people have less bone to lose compared to larger individuals
- Menopause: Oestrogen has a protective effect on bone. Menopausal women are likely to start losing bone at a faster rate
- Family history: Poor bone health can be hereditary
- Medications: Some medications have side effects that are linked to increased fracture risk
Factors that can be managed through lifestyle changes include:
- Excess alcohol consumption
- Tobacco use
- Low body mass index: being underweight is a significant risk factor
- Poor nutrition
- Low calcium intake: if there is not enough calcium in the blood, the body will take calcium from bones and bones will become weaker
- Low vitamin D levels: Vitamin D is needed to absorb calcium
- Sedentary lifestyle: Exercise is very important for normal bone formation and adult bone health
How does alcohol affect your bones?
Exploring the relationship between alcohol consumption and osteoporosis has been a focus of research for a number of years. Research findings, as indicated by two large studies, highlight that alcohol can have a negative impact on bone health.
A study published in 2005 found that drinking more than one to two ounces of alcohol a day increased the risk of osteoporotic fracture (Kanis et al., 2005). A second study published in 2009, found bone mineral density was significantly lower in the hip and spine when more than two drinks a day were consumed (Tucker, K. L., 2009).
Is Moderate Alcohol Consumption Good or Bad for Bone Health?
Some studies suggest that moderate alcohol intake may help reduce osteoporosis and even decrease fracture risk. For example:
A study of young Korean women indicated that frequent and copious drinking was related to low bone mineral density and osteoporosis. However the study found higher BMD counts in women where alcohol consumption was lighter. The study concluded that non-drinkers and heavy drinkers had a greater risk of developing osteoporosis (Hong H.D., et al., 2017).
In 2018, a comprehensive review identified links between consumption of alcohol and osteoporosis but noted that low to moderate alcohol intake may have protective effects on bone health in elderly women (Pouresmaeili, 2018).
A meta-analysis of relevant research published in 2022 found consistent evidence that increased alcohol consumption is associated with a higher risk of osteoporotic hip fractures. However the analysis noted that the influence of lower consumption is uncertain, as bone density was higher in light drinkers when compared to abstainers (Godos et al. 2022)
Researchers suggest that these studies be interpreted cautiously as they have some imitations. They argue that studies need to consider the interaction between alcohol consumption and other variables that impact on bone health (Jang, 2017).
While the research findings on moderate drinkers and osteoporosis is mixed, there is strong evidence that chronic heavy drinking has major negative effects on bone health at all ages. The evidence also shows that heavy alcohol use during adolescence and young adult years can increase the risk of osteoporosis later in life.
How alcohol consumption can increase osteoporosis risk
Research has identified several ways in which excessive alcohol consumption can have a negative impact on a person’s bone health, thereby increasing the risk of developing osteoporosis. The effects often occur indirectly as alcohol influences the growth factors that regulate bone metabolism. Possible effects relate to vitamin and mineral absorption, hormone production, bone cell turnover and increased risk of falls and fractures
Vitamin and Mineral Absorption
Heavy drinking appears to negatively impact how the body produces and absorbs calcium and vitamin D. Calcium is an essential nutrient for healthy bones while people need vitamin D for their bones to absorb calcium.. A lack of calcium absorption sees bones decline. This impacts on overall bone density and bone health.
Hormone production
Heavy drinking can cause deficiencies in hormones such as oestrogen and testosterone. These are fundamental to bone health. In women alcohol may contribute to a drop in oestrogen levels resulting in a slowing of bone remodelling. In menopausal years in particular, this loss can be in addition to the bone loss that’s naturally occurring. Testosterone in men helps bones to form. Chronic alcohol consumption (especially in young men) can disrupt testosterone levels and thus bone development.
Bone cell turnover
Too much alcohol can negatively affect bone-building cells and the resorption process. This can result in deficient bone repair and increased risk of bone fracture.
Increased risk of falls and fracture
The more alcohol a person drinks, the greater their risk of becoming intoxicated and falling. If bone density is already depleted, as for example with older adults, the individual is more susceptible to breaking bones as a result of a fall.
Is it safe to drink after being diagnosed with osteoporosis?
Research clearly indicates that heavy and frequent drinking of alcohol can worsen osteoporosis and increase the risk of bone fractures. However some researchers and professionals suggest that occasional consumption of alcohol may be safe for most people. This is particularly the case if moderate drinking is combined with a well-balanced diet, exercise and strategies to manage other risk factors. However, it is also recommended that people with osteoporosis do limit their alcohol intake.
Expert advice
Early intervention and diagnosis can help manage osteoporosis. At EP360, we offer assessments and guidance, take into consideration health conditions and recommend appropriate treatment and management strategies to ensure that you mitigate, as much as you can, the likelihood of suffering a fracture and helping to ensure that reverse the process of bone degradation.
Alcohol and Osteoporosis – Summary
Strong, healthy bones are important. They provide structure and support for our bodies, protect our organs, and store calcium and other essential minerals. Bone development, or bone modelling, is a lifelong process. In children and adolescents bones grow rapidly, increasing in bone mass and strength. In younger, healthier adults, similar amounts of bone are removed and replaced. The body reaches peak bone mass. Achieving this peak enables bones to store the calcium the body may need throughout life. In older adults bone mass, or bone mineral density, begins to decrease. Bones may become brittle and susceptible to fractures and breaks. There is a risk of developing osteoporosis.
Heavy alcohol consumption has been identified as a risk factor in development of osteoporosis. Long-term alcohol consumption can interfere with bone formation and replacement of bone tissue. Research has identified alcohol consumption as specifically impacting on nutrient absorption, particularly calcium. A lack of calcium impacts on overall bone density.
Heavy drinking at all ages can also cause deficiencies in hormones such as oestrogen and testosterone that are fundamental to bone strength. It can also negatively affect bone-building cells and the resorption process, increasing the risk of breaks and fractures.
People may help reduce their risk of developing osteoporosis by limiting their alcohol intake, as well as making other lifestyle changes to manage identified risk factors.
Information in this article is not intended as a substitute for informed professional advice. If you or someone you know is concerned about the issues raised in this discussion, you should consult with an appropriate healthcare professional.
References
Australian Institute of Health (2014), Estimating the Prevalence of Osteoporosis in Australia
https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/estimating-the-prevalence-of-osteoporosis-in-austr/summary
Godos J, Giampieri F, Chisari E, Micek A, Paladino N, Forbes-Hernández TY, Quiles JL, Battino M, La Vignera S, Musumeci G, Grosso G. (2022) Alcohol Consumption, Bone Mineral Density, and Risk of Osteoporotic Fractures: A Dose-Response Meta-Analysis. Int J Environ Res Public Health. 2022 Jan 28;19(3):1515. doi: 10.3390/ijerph19031515. PMID: 35162537; PMCID: PMC8835521.
Jang H-D, Hong J-Y, Han K, Lee JC, Shin B-J, Choi S-W, et al. (2017) The relationship between bone mineral density and alcohol intake: A nationwide health survey analysis of postmenopausal women. PLoS ONE 12(6): e0180132. https://doi.org/10.1371/journal. pone.0180132
Kanis, J. A., H. Johansson, O. Johnell, et al. 2005. Alcohol intake as a risk factor for fracture. Osteoporos Int Jul;16(7):737–42.
Pouresmaeili F, Kamalidehghan B, Kamarehei M, Goh YM. A comprehensive overview on osteoporosis and its risk factors. Ther Clin Risk Manag. 2018 Nov 6;14:2029-2049. doi: 10.2147/TCRM.S138000. PMID: 30464484; PMCID: PMC6225907.
Tucker, K. L., 2009. Jugdaohsingh R, Powell JJ, et al. Effects of beer, wine, and liquor intakes on bone mineral density in older men and women. Am J Clin Nutr Apr;89(4):1188–96
