Association between alcohol consumption and both osteoporotic fracture and bone density

Abstract

Objective: Alcoholism is a risk factor for osteoporotic fractures and low bone density, but the effects of moderate alcohol consumption on bone are unknown. We performed a systematic review and meta-analysis to assess the associations between alcohol consumption and osteoporotic fractures, bone density and bone density loss over time, bone response to estrogen replacement, and bone remodeling.

Methods: MEDLINE, Current Contents, PsychINFO, and Cochrane Libraries were searched for studies published before May 14, 2007. We assessed quality using the internal validity criteria of the US Preventive Services Task Force.

Results: We pooled effect sizes for 2 specific outcomes (hip fracture and bone density) and synthesized data qualitatively for 4 outcomes (non-hip fracture, bone density loss over time, bone response to estrogen replacement, and bone remodeling). Compared with abstainers, persons consuming from more than 0.5 to 1.0 drinks per day had lower hip fracture risk (relative risk=0.80 [95% confidence interval, 0.71-0.91]), and persons consuming more than 2 drinks per day had higher risk (relative risk=1.39 [95% confidence interval, 1.08-1.79]). A linear relationship existed between femoral neck bone density and alcohol consumption. Because studies often combined moderate and heavier drinkers in a single category, we could not assess relative associations between alcohol consumption and bone density in moderate compared with heavy drinkers.

Conclusion: Compared with abstainers and heavier drinkers, persons who consume 0.5 to 1.0 drink per day have a lower risk of hip fracture. Although available evidence suggests a favorable effect of alcohol consumption on bone density, a precise range of beneficial alcohol consumption cannot be determined.

Figure 1

Study selection process. Studies may be excluded for multiple reasons.

Figure 2

Association between alcohol consumption and hip fracture risk. Reference exposure is zero drinks per day. Size of data marker represents sample size. Horizontal lines denote 95% confidence intervals.

Figure 3

Association between alcohol consumption and adjusted femoral neck bone mineral density. Adjustment for confounders is variable. Study adjusting for the fewest covariates controlled for age, smoking, weight, and height. Study adjusting for the most covariates also controlled for leisure time physical activity, difficulty arising from a bed or chair, estrogen therapy, thiazide-type diuretics, thyroid agents, race, diabetes, hypertension, cardiovascular disease, visual problems, arthritis, previous cancer, weight in early teens, and Mini-Mental Status Exam score.