Osteoporosis International

, Volume 16, Issue 7, pp 737–742 | Cite as

Alcohol intake as a risk factor for fracture

  • John A. KanisEmail author
  • Helena Johansson
  • Olof Johnell
  • Anders Oden
  • Chris De Laet
  • John A. Eisman
  • Huibert Pols
  • Alan Tenenhouse
Original Article


High intakes of alcohol have adverse effects on skeletal health, but evidence for the effects of moderate consumption are less secure. The aim of this study was to quantify this risk on an international basis and explore the relationship of this risk with age, sex, and bone mineral density (BMD). We studied 5,939 men and 11,032 women from three prospectively studied cohorts comprising CaMos, DOES, and the Rotterdam Study. Cohorts were followed for a total of 75,433 person-years. The effect of reported alcohol intake on the risk of any fracture, any osteoporotic fracture, and hip fracture alone was examined using a Poisson model for each sex from each cohort. Covariates examined included age and BMD. The results of the different studies were merged using weighted β-coefficients. Alcohol intake was associated with a significant increase in osteoporotic and hip fracture risk, but the effect was nonlinear. No significant increase in risk was observed at intakes of 2 units or less daily. Above this threshold, alcohol intake was associated with an increased risk of any fracture (risk ratio [RR]=1.23; 95% CI, 1.06–1.43), any osteoporotic fracture (RR=1.38; 95% CI, 1.16–1.65), or hip fracture (RR=1.68; 95% CI, 1.19–2.36). There was no significant interaction with age, BMD, or time since baseline assessment. Risk ratios were moderately but not significantly higher in men than in women, and there was no evidence for a different threshold for effect by gender. We conclude that reported intake of alcohol confers a risk of some importance beyond that explained by BMD. The validation of this risk factor on an international basis permits its use in case-finding strategies.


Alcohol Hip fracture Meta-analysis Osteoporotic fracture Risk factors 



We are grateful to the International Osteoporosis Foundation, National Osteoporosis Foundation, International Society for Clinical Densitometry, and the European Community (EU FP 3/5) for their support. We gratefully acknowledge G-E Lunar, Lilly, Hologic, Roche, IGEA, the Alliance for Better Bone Health, Novartis, and Wyeth for their unrestricted support of this work.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • John A. Kanis
    • 1
    Email author
  • Helena Johansson
    • 2
  • Olof Johnell
    • 3
  • Anders Oden
    • 2
  • Chris De Laet
    • 4
  • John A. Eisman
    • 5
  • Huibert Pols
    • 6
  • Alan Tenenhouse
    • 7
  1. 1.WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of Sheffield Medical SchoolSheffieldUK
  2. 2.Consulting StatisticianGothenburgSweden
  3. 3.Department of OrthopaedicsMalmo General HospitalMalmoSweden
  4. 4.Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands
  5. 5.Bone and Mineral Research Program, Garvan Institute of Medical ResearchSt Vincent’s Hospital and University of NSWSydneyAustralia
  6. 6.Department of Internal MedicineErasmus UniversityRotterdamThe Netherlands
  7. 7.Division of Bone MetabolismThe Montreal General HospitalMontrealCanada

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