Alcohol consumption, bone density, and hip fracture among older adults: the cardiovascular health study
- 597 Downloads
Previous studies have found inconsistent relationships of alcohol consumption with risk of hip fracture, and the importance of bone mineral density and risk of falls in mediating such a relationship has not been determined.
As part of the Cardiovascular Health Study, a population-based cohort study of adults aged 65 years and older from four U.S. communities, 5,865 participants reported their use of beer, wine, and liquor yearly. We identified cases of hip fracture unrelated to malignancy or motor vehicle accidents using hospitalization discharge diagnoses. A subgroup of 1,567 participants in two communities underwent dual-energy x-ray absorptiometry scans to assess bone mineral density.
A total of 412 cases of hip fracture occurred during an average of 12 years of follow-up. There was a significant U-shaped relationship between alcohol intake and risk of hip fracture (p quadratic 0.02). Compared with long-term abstainers, the adjusted hazard ratios for hip fracture were 0.78 (95% confidence interval [CI], 0.61–1.00) among consumers of up to 14 drinks per week and 1.18 (95% CI, 0.77–1.81) among consumers of 14 or more drinks per week. Alcohol intake was associated with bone mineral density of the total hip and femoral neck in a stepwise manner, with approximately 5% (95% CI, 1%–9%) higher bone density among consumers of 14 or more drinks per week than among abstainers. These relationships were all similar among men and women.
Among older adults, moderate alcohol consumption has a U-shaped relationship with risk of hip fracture, but a graded positive relationship with bone mineral density at the hip.
KeywordsAlcohol Bone mineral density Epidemiology Hip fracture Nutrition
The research reported in this article was supported by contracts N01-HC-85079 through N01-HC-85086, N01-HC-35129, and N01 HC-15103 from the National Heart, Lung, and Blood Institute, which has approved the paper. The bone density scans were funded by the National Institute on Aging (intra-agency agreements Y02-AG-4-0251 and 1-Y02-HC-40205). A full list of participating CHS investigators and institutions can be found at http://www.chs-nhlbi.org.
- 12.Smeets-Goevaers CG, Lesusink GL, Papapoulos SE, Maartens LW, Keyzer JJ, Weerdenburg JP, Beijers LM, Zwinderman AH, Knottnerus JA, Pols HA, Pop VJ (1998) The prevalence of low bone mineral density in Dutch perimenopausal women: the Eindhoven perimenopausal osteoporosis study. Osteoporos Int 8:404–409PubMedCrossRefGoogle Scholar
- 25.Suzuki T, Yoshida H, Hashimoto T, Yoshimura N, Fujiwara S, Fukunaga M, Nakamura T, Yoh K, Inoue T, Hosoi T, Orimo H (1997) Case-control study of risk factors for hip fractures in the Japanese elderly by a Mediterranean Osteoporosis Study (MEDOS) questionnaire. Bone 21:461–467PubMedCrossRefGoogle Scholar
- 49.Willett WC (1998) Chapter 13: Issues in analysis and presentation of dietary data. In:Willett WC (ed) Nutritional epidemiology, 2nd edn. Oxford University Press, New YorkGoogle Scholar
- 53.Hines LM, Hankinson SE, Smith-Warner SA, Spiegelman D, Kelsey KT, Colditz GA, Willett WC, Hunter DJ (2000) A prospective study of the effect of alcohol consumption and ADH3 genotype on plasma steroid hormone levels and breast cancer risk. Cancer Epidemiol Biomarkers Preven 9:1099–1105Google Scholar
- 54.Dorgan JF, Baer DJ, Albert PS, Judd JT, Brown ED, Corle DK, Campbell WS, Hartman TJ, Tejpar AA, Clevidence BA, Giffen CA, Chandler DW, Stanczyk FZ, Taylor PR (2001) Serum hormones and the alcohol-breast cancer association in postmenopausal women. J Natl Cancer Inst 93:710–715PubMedCrossRefGoogle Scholar
- 55.Sierksma A, Sarkola T, Eriksson CJ, van der Gaag MS, Grobbee DE, Hendriks HF (2004) Effect of moderate alcohol consumption on plasma dehydroepiandrosterone sulfate, testosterone, and estradiol levels in middle-aged men and postmenopausal women: a diet-controlled intervention study. Alcohol Clin Exp Res 28:780–785PubMedCrossRefGoogle Scholar
- 56.Smith-Warner SA, Spiegelman D, Yaun S-S, Adami HO, van den Brandt PA, Folsom AR, Goldbohm RA, Graham S, Howe GR, Marshall JR, Miller AB, Potter JD, Speizer FE, Willett WC, Wolk A, Hunter DJ (1998) Alcohol and breast cancer in women: a pooled analysis of cohort studies. J Am Med Assoc 279:535–540CrossRefGoogle Scholar
- 59.Meunier PJ, Sebert JL, Reginster JY, Briancon D, Appelboom T, Netter P, Loeb G, Rouillon A, Barry S, Evreux JC, Avouac B, Marchandise X (1998) Fluoride salts are no better at preventing new vertebral fractures than calcium-vitamin D in postmenopausal osteoporosis: the FAVO Study. Osteoporos Int 8:4–12PubMedCrossRefGoogle Scholar
- 65.American Geriatrics Society Clinical Practice Committee (1997) Clinical guidelines on alcohol use disorders in older adults. American Geriatrics Society, New York, N.Y.Google Scholar