Osteoporosis and Alcohol

When it comes to how much alcohol is healthy for adults to consume, you may have heard the oft-stated recommendation that it’s generally safe for most women to have one drink of alcohol per day and for most men to have two drinks daily. But if you have osteoporosis or low bone density (osteopenia), is it still safe to drink alcohol?

Osteoporosis is a degenerative disease that causes bones to be weakened and thinned to the point that they can fracture more easily. Alcohol can play a role in how dense bones are, the speed with which bone cells rebuild, and how your body absorbs important bone-forming nutrients. Alcohol consumption can be an important consideration when it comes to osteoporosis prevention and management.

You should talk to your physician for their recommendations about alcohol consumption and your specific health conditions, your health history, and use with medications you’ve been prescribed.

Here, learn more about considerations to keep in mind when it comes to the connection between alcohol and osteoporosis.

Is Moderate Alcohol Good or Bad for Bone Health?

Depending on which articles you read, you may come across mixed headlines about whether drinking alcohol in moderation is good or bad for your bone health.

In the past, some studies pointed out the potential benefits of alcohol for bone health: A 2008 study in the American Journal of Medicine found that people who consume about one alcoholic drink a day had lower risk of hip fractures than abstainers. Earlier British research concluded that women over 65 who consumed more than five drinks per week had lower risks of vertebral deformity than those who had one drink per week.

However, much of the research on alcohol and osteoporosis risk is observational, which means that it can’t conclude cause and effect. More recently, updated science has challenged the idea that drinking alcohol is “good” for bone health.

For example, an analysis of six studies published in the journal Drug and Alcohol Dependence earlier this year found a positive relationship between alcohol consumption and osteoporosis — in other words, that alcohol was linked with greater odds of osteoporosis. The study found that compared with abstainers:

  • People who consumed 0.5 to 1 drink per day had 1.38 times the risk of developing osteoporosis.
  • People who consumed 1 to 2 drinks per day had 1.34 times the risk of developing osteoporosis.
  • People who consumed 2 drinks or more per day had 1.63 times the risk of developing osteoporosis.

The Challenges of Studying Alcohol Consumption

“Alcohol is very challenging to study and the variability of the results in these studies is most likely because most of the effects of moderate alcohol consumption on bone are subtle,” says Russell T. Turner, PhD, a researcher at the Skeletal Biology Laboratory at Oregon State University in Corvallis, Oregon who studies how exercise, nutrition, and lifestyle interact to influence skeletal health. “If alcohol has any beneficial or detrimental effect, it’s probably going to be over a really long term.”

Dr. Turner wrote a review paper in Clinical Reviews in Bone and Mineral Metabolism that challenged the assumption that moderate alcohol intake is considered beneficial and heavy drinking detrimental. Even small quantities of alcohol can have detrimental skeletal effects and not all studies report clinically relevant bone loss with long-duration alcohol abuse, according to the paper. Factors such as the following should be considered:

  • Age
  • Sex
  • Skeletal site
  • Age of onset of drinking
  • Duration of drinking
  • Comorbidities

Based on the finding that alcohol alters the peptides that influence bone metabolism, Dr. Turner says there is no way to predict which individuals are most likely to be impacted favorably or unfavorably by alcohol consumption.

In addition, alcohol consumption in many of the studies is self-reported. Study participants might have to think back on whether they had one drink a day or two over the past year, explains Dr. Turner. Their memory versus actual occurrence could lead to discrepancies. Then you have to factor in that the size of one person’s alcoholic drink (like wine) may differ significantly from person to person.

Dr. Turner worked on a review of studies published in the journal Alcoholism, Clinical, and Experimental Research that found that light-to-moderate drinking might have beneficial effects on older adults by slowing bone remodeling. However, he says, the study is not conclusive. Plus, alcohol’s effect on younger adults’ skeleton and bone remodeling is less certain. “In people who are careful, moderate drinkers, then it’s unlikely that [alcohol] is going to lead to any type of skeletal issue,” he says.

In another example, a small study in the journal Menopause on postmenopausal women found that when women stopped drinking alcohol for two weeks, they showed increased markers of bone turnover (which increases the risk of osteoporosis). When the women resumed alcohol consumption, they had slower bone turnover.

“One of the big risk factors for osteoporosis in the aging population is elevated bone turnover,” says Dr. Turner. “That influences the quality of the bone. This study suggested that in this population some alcohol might be beneficial. Lowering bone turnover in a younger, growing person, however, may not be so good. So age may be an important factor,” he says.

That said, “until we can do a controlled study and come up with a marker that shows how much alcohol someone has consumed, then one study’s going to show a positive, another study’s going to show a neutral, another study’s going to show negative impact on bone health,” says Dr. Turner. “The likely reason we’re seeing this [variability] is that, in reality, there is likely not much of a positive or negative effect [on bone health] from moderate alcohol consumption.”

Heavy Drinking and Osteoporosis

Even if the research on moderate drinking and osteoporosis is mixed, there is solid research that chronic heavy drinking does increase the risk of osteoporosis, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. A 2018 Korean study found that heavy drinking was associated with lower bone mineral density. The prevalence of osteopenia is between 34 and 48 percent among those with alcoholic liver disease and the prevalence of osteoporosis for this population is between 11 and 36 percent, according to a 2016 Indian study.

“We know that alcohol abuse can have detrimental effects on bone health,” says Dr. Turner. “What we don’t know is how much of the effect is alcohol directly on bone versus the other comorbidities that occur with alcohol abusers.”

Other associations may come into play, like poor diet; or problems with pancreatitis, diabetes, or liver disease. “All of these are known to negatively affect the skeleton,” he says. “The take-home message to the typical person is that alcohol abuse is bad. And whether it’s a direct or indirect effect on bone, it’s still a negative effect.”

One study published in the Journal of Studies on Alcohol and Drugs examined the association between heavy episodic drinking and college-age women’s bone density test scores. They defined “heavy episodic drinking” as having four or more drinks within two hours on 115 or more occasions since the start of high school, about 1.6 episodes per month over this period. The researchers found decreased bone mineral density in the vertebrae of those women who had more instances of binge drinking episodes, which suggests that heavy drinking before women have reached peak bone mass — which usually occurs by the late twenties — could negatively impact skeletal health.

On the plus side, it’s been discovered that when someone with a history of alcohol abuse abstains from drinking, their body can kick-start osteoblastic (bone-building) activity again.

How Excess Alcohol Consumption Affects Bone Density

Alcohol in excess can have negative effects on bones, muscles, and joints in a few different ways:

Vitamin and mineral absorption

Heavy drinking negatively impacts bone health because it affects nutrient absorption, says Scott Boden, MD, Professor of Orthopedic Surgery at Emory University School of Medicine and Director of the Emory Orthopaedics & Spine Center in Atlanta, Georgia.

Alcohol consumption impacts how the body absorbs calcium and vitamin D, both of which are critical for healthy bone development. “Alcohol can decrease the absorption of calcium via the intestine, or it can have effects on the pancreas and vitamin D metabolism, which can impact bone density,” says Dr. Boden.

When alcohol disrupts vitamin D and its ability to help the body absorb calcium, it impacts your body’s ability to build strong bones and overall bone density, putting you at a higher risk for fractures after falls.

Hormone production

Research finds that chronic heavy drinking can cause hormone deficiencies in men and women. Men with alcoholism may produce less testosterone, a hormone linked to the production of osteoblasts (cells that stimulate bone formation). In women, overconsumption of alcohol can decrease estrogen, which can negatively impact bone density, says Dr. Boden. Estrogen can inhibit bone breakdown and may stimulate bone formation. That’s why a decrease in estrogen during menopause is associated with bone loss.

Bone cell turnover

Too much alcohol negatively affects bone-building osteoblast cells in other ways. Chronic drinking suppresses osteoblastic differentiation of bone marrow cells that are crucial to the building process and also contribute to repair of deficient bone. This can increase the risk of bone fracture, according to research in the journal Alcoholism: Clinical and Experimental Research.

Fall risk

This may sound obvious, but the more alcohol you drink, the greater your risk for becoming intoxicated and falling, which can make osteoporotic fractures more likely if you’re already prone to thin, weak bones.

Types of Alcohol and Their Effect on Osteoporosis

Some research has suggested that beer may be “better for bone health” than other kinds of alcohol because some kinds of beer have high levels of the mineral silicon. Research in the Journal of Bone and Mineral Research found an association between greater dietary silicon intake and higher bone mineral density in the hip. Another study showed that moderate wine consumption may offer bone protection because wine is rich in phenolic compounds, strong phytoestrogens and natural antioxidants–all of which contribute to bone protection.

Other research published in the American Journal of Clinical Nutrition looked at the bone mineral density of men and women, noting that among the subjects, men tended to drink beer and women preferred wine. The men who consumed one to two drinks of beer or alcohol daily had higher bone mineral density than non-drinking men. Postmenopausal women who consumed one to two drinks per day had a higher bone mineral density in the spine and hip area than non-drinking women.

The authors concluded that the “tendency toward stronger associations between [bone density] and beer or wine, relative to liquor, suggests that constituents other than ethanol may contribute to bone health.” In other words, it may not be just the alcohol itself that plays a role in effect on bone health, but other compounds in beverages like wine, beer, and spirits.

However, more research is needed before experts are willing to concede that a particular type of alcohol is better for bone density than another. Far more important than alcohol type is simply quantity — and making sure you don’t consume excessive amounts.

Drinking Alcohol with Osteoporosis: Is It Safe?

No one would suggest that you start drinking alcohol in moderation to improve your bone health. But if moderate drinking is part of your lifestyle and you’ve been diagnosed with low bone density or osteoporosis and aren’t sure if it’s safe to have the occasional alcoholic beverage, talk to your doctor. They should take your entire health history and prescribed medications into account before making a recommendation.

Occasional consumption of alcohol is likely safe even if you’re at risk for osteoporosis, have been told you have osteopenia, or received an osteoporosis diagnosis. For many patients, “a glass of wine a day should not be an issue when combined with a well-balanced diet with calcium, vitamin D, and exercise,” says Dr. Boden.

“Whether you’re at risk or have been diagnosed with osteoporosis, if someone is having some alcohol as part of a healthy lifestyle, I don’t see that there’s likely to be any negative skeletal consequences to that,” says Dr. Turner.

To reduce your risk of falls and fractures, “make sure you’re focused on good nutrition, moderate physical activity, and a healthy lifestyle overall,” says Dr. Turner. Read more here about how to prevent osteoporosis through diet, exercise, medication, and more.

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LaBrie J, et al. Heavy episodic drinking Is associated with poorer bone health in adolescent and young adult women. Journal of Studies on Alcohol and Drugs. May 2018. doi: http://doi.org/10.15288/jsad.2018.79.391.

Marrone J, et al. Moderate alcohol intake lowers biochemical markers of bone turnover in postmenopausal women. Menopause. September 19, 2012. doi: http://doi.org/10.1097/gme.0b013e31824ac071.

Tucker K, et al. Effects of beer, wine, and liquor intakes on bone mineral density in older men and women. American Journal of Clinical Nutrition. February 25, 2009. doi: http://doi.org/10.3945/ajcn.2008.26765.

Turner R. et al. Making sense of the highly variable effects of alcohol on bone. Clinical Reviews in Bone and Mineral Metabolism. July 31, 2021. doi: https://link.springer.com/article/10.1007/s12018-021-09277-8.

Wang X, et al. Alcoholism and Osteoimmunology. Current Medicinal Chemistry. 2021. doi: 10.2174/1567201816666190514101303

Interview with Scott Boden, MD, Professor of Orthopedic Surgery at Emory University School of Medicine and Director of the Emory Orthopaedics & Spine Center in Atlanta, Georgia.

Interview with Russell T. Turner, PhD, a researcher at the Skeletal Biology Laboratory at Oregon State University in Corvallis, Oregon.

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