Advertisement

Wiener Medizinische Wochenschrift

, Volume 164, Issue 1–2, pp 15–24 | Cite as

Alcohol and bone

  • Peter MikoschEmail author
main topic

Summary

Alcohol is widely consumed across the world in different cultural and social settings. Types of alcohol consumption differ between (a) light, only occasional consumption, (b) heavy chronic alcohol consumption, and (c) binge drinking as seen as a new pattern of alcohol consumption among teenagers and young adults. Heavy alcohol consumption is detrimental to many organs and tissues, including bones. Osteoporosis is regularly mentioned as a secondary consequence of alcoholism, and chronic alcohol abuse is established as an independent risk factor for osteoporosis. The review will present the different mechanisms and effects of alcohol intake on bone mass, bone metabolism, and bone strength, including alcoholism-related “life-style factors” such as malnutrition, lack of exercise, and hormonal changes as additional causative factors, which also contribute to the development of osteoporosis due to alcohol abuse.

Keywords

Alcohol abuse Osteoporosis Bone Liver metabolism Vitamin D 

Alkohol und Knochen

Zusammenfassung

Alkohol wird weltweit konsumiert, wobei Ausmaß sowie Art und Weise des Alkoholgenusses stark von sozialen, kulturellen und religiösen Faktoren beeinflusst werden. Betreffend Art und Intensität des Alkoholkonsums kann im Wesentlichen zwischen a) leichtem unregelmäßigen, b) schwerem chronischen und c) binge drinking (Komatrinken) unterschieden werden. Regelmäßiger Alkoholkonsum in größeren Mengen hat schwerwiegende negative Auswirkungen auf verschiedene Organe, so auch auf den Knochen. Am Knochen entwickelt sich durch Alkoholeinwirkung eine Osteoporose, wobei die pathophysiologischen Mechanismen dabei komplex erscheinen. Chronischer Alkoholgenuss wird folglich als eigenständiger Risikofaktor für Osteoporose angeführt. Die Übersicht stellt die unterschiedlichen Mechanismen und Effekte von Alkohol in der Osteoporoseentstehung dar. Neben den direkten Auswirkungen von Alkohol auf die Knochenmasse, Knochenstoffwechsel und Knochenstärke werden auch mit Alkohol assoziierte hormonelle Veränderungen sowie negative Lebensumstände wie Mangelernährung, verminderte körperliche Aktivität als Ursachen dargestellt.

Schlüsselwörter

Alkohol Osteoporose Knochen Lebermetabolismus Vitamin D 

References

  1. 1.
    Frost M, Wraae K, Gudex C, et al. Diseases in elderly men: underreporting and underdiagnosis. Age Ageing. 2012;41:177–83. doi:10.1093/ageing/afr153.CrossRefPubMedGoogle Scholar
  2. 2.
    Gómez Navarro R. [Prevalence of risk factors for fragility fracture in men aged 40 to 90 years of a Spanish basic Rural Health Area]. Rev Esp Salud Publica. 2011;85:491–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Vestergaard P, Rejnmark L, Mosekilde L. Socioeconomic aspects of fractures within universal public healthcare: a nationwide case-control study from Denmark. Scand J Public Health. 2006;34:371–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Audran M, Cortet B. Prevalence of osteoporosis in male patients with risk factors. Presse Med. 2011;40:e489–98. doi:10.1016/j.lpm.2011.08.002.CrossRefPubMedGoogle Scholar
  5. 5.
    Legroux-Gerot I, Blanchaert F, Solau-Gervais E, et al. Causes of osteoporosis in males. A review of 160 cases. Rev Rhum Engl Ed. 1999;66:404–9.PubMedGoogle Scholar
  6. 6.
    Laitinen K, Välimäki M. Alcohol and bone. Calcif Tissue Int. 1991;49 Suppl:S70–3.CrossRefPubMedGoogle Scholar
  7. 7.
    Suh KT, Kim SW, Roh HL, et al. Decreased osteogenic differentiation of mesencymal stem cells in alcohol-induced osteonecrosis. Clin Orthop Relat Res. 2005;431:220–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Wang Y, Li Y, Mao K, et al. Alcohol-induced adipogenesis in bone and marrow: a possible mechanism for osteonecrosis. Clin Orthop Relat Res. 2003;410:213–24.CrossRefPubMedGoogle Scholar
  9. 9.
    Friday KE, Howard GA. Ethanol inhibits human bone cell proliferation and function in vitro. Metabolism. 1991;40:562–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Chavassieux P, Serre CM, Vergnaud P, et al. In vitro evaluation of dose-effects of ethanol on human osteoblastic cells. Bone Miner. 1993;22:95–103.CrossRefPubMedGoogle Scholar
  11. 11.
    Dai J, Lin D, Zhang J, et al. Chronic alcohol ingestion induces osteoclastogenesis and bone loss through IL-6 in mice. J Clin Invest. 2000;106:887–95.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Klein RF, Fausti KA, Carlos AS. Ethanol inhibits human osteoblastic cell proliferation. Alcohol Clin Exp Res. 1996; 20:572–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Maurel DB, Boisseau N, Benhamou CL, Jaffre C. Alcohol and bone: review of dose effects and mechanisms. Osteoporos Int. 2012;23:1–16.CrossRefPubMedGoogle Scholar
  14. 14.
    García-Valdecasas-Campelo E, González-Reimers E, Santolaria-Fernández F, et al. Serum osteoprotegerin and RANKL levels in chronic alcoholic liver disease. Alcohol Alcohol. 2006;41:261–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Fabrega E, Orive A, Garcia-Suarez C, et al. Osteoprotegerin and RANKL in alcoholic liver cirrhosis. Liver Int. 2005;25:305–10.CrossRefPubMedGoogle Scholar
  16. 16.
    Santori C, Ceccanti M, Diacinti D, et al. Skeletal turnover, bone mineral density, and fractures in male chronic abusers of alcohol. J Endocrinol Invest. 2008;31:321–6.PubMedGoogle Scholar
  17. 17.
    González-Reimers E, Martín-González C, de la Vega-Prieto MJ, et al. Serum sclerostin in alcoholics: a pilot study. Alcohol Alcohol. 2013;48:278–82. doi:10.1093/alcalc/ags136.CrossRefPubMedGoogle Scholar
  18. 18.
    Chen JR, Haley RL, Hidestrand M, et al. Ertradiol protects against ethanol-induced bone loss by inhibiting up-regulation of receptor activator of nuclear factor-kappaB in osteoblasts. J Pharmacol Exp Ther. 2006;319:1182–90.CrossRefPubMedGoogle Scholar
  19. 19.
    Ronis MJ, Mercer K, Chen JR. Effects of nutrition and alcohol consumption on bone loss. Curr Osteoporos Rep. 2011;9:53–9.PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Chen JR, Badger TM, Nagaragian S, Ronis MJJ. Inhibition of reactive oxygen species generation and downstream activation of the ERK/STAT3/RANKL-signaling cascade to osteoblasts accounts for the protective effects of estradiol on ethanol-induced bone loss. J Pharmacol Exp Ther. 2008;324:50–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Kim MJ, Shim MS, Kim MK, et al. Effect of chronic alcohol ingestion on bone mineral density in males without liver cirrhosis. Korean J Intern Med. 2003;18:174–80.PubMedGoogle Scholar
  22. 22.
    Wezeman FH, Emanuele MA, Emanuele NV, et al. Chronic alcohol consumption during male rat adolescence impairs skeletal development through effects on osteoblast gene expression, bone mineral density, and bone strength. Alcohol Clin Exp Res. 1999;23:1534–42.CrossRefPubMedGoogle Scholar
  23. 23.
    Hogan HA, Sampson HW, Cashier E, Ledoux N. Alcohol consumption by young actively growing rats: a study of cortical bone histomorphometry and mechanical properties. Alcohol Clin Exp Res. 1997;21:809–16.PubMedGoogle Scholar
  24. 24.
    Mercer KE, Wynne RA, Lazarenko OP, et al. Vitamin D supplementation protects against bone loss associated with chronic alcohol administration in female mice. J Pharmacol Exp Ther. 2012;343:401–12. doi:10.1124/jpet.112.197ß38.Google Scholar
  25. 25.
    Nyquist F, Düppe H, Obrant KJ, et al. Effects of alcohol on bone mineral and mechanical properties of bone in male rats. Alcohol Alcohol. 2002;37:21–4.CrossRefPubMedGoogle Scholar
  26. 26.
    Sibonga JD, Iwaniec UT, Shogren KL, et al. Effects of parathyroid hormone (1–34) on tibia in the adult rat model for chronic alcohol abuse. Bone. 2007;40:1013–20.CrossRefPubMedGoogle Scholar
  27. 27.
    Wezeman FH, Juknelis D, Frost N, Callarci JJ. Spine bone mineral density and vertebral body height are altered by alcohol consumption in growing male and female rats. Alcohol. 2003;31:87–92.PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Hogan HA, Groves JA, Sampson HW. Long-term alcohol consumption in the rat affects femur cross-sectional geometry and bone tissue material properties. Alcohol Clin Exp Res. 1999;23:1825–33.CrossRefPubMedGoogle Scholar
  29. 29.
    Hogan HA, Argueta F, Moe L, et al. Adult-onset alcohol consumption induces osteopenia in female rats. Alcohol Clin Exp Res. 2001;25:746–54.CrossRefPubMedGoogle Scholar
  30. 30.
    Trevisiol CH, Turner RT, Pfaff JE, et al. Impaired osteoinduction in a rat model for chronic alcohol abuse. Bone. 2007;41:175–80.Google Scholar
  31. 31.
    Lauing K, Himes R, Rachwalski M, et al. Binge alcohol treatment of adolescent rats followed by alcohol abstinence is associated with site-specific differences in bone loss and incomplete recovery of bone mass and strength. Alcohol. 2008;42:649–56. doi:10.1016/j.alcohol.2008.08.005.PubMedCentralCrossRefPubMedGoogle Scholar
  32. 32.
    Shimizu Y, Sakai A, Menuki K, et al. Reduced bone formation in alcohol-induced osteopenia is associated with elevated p21 expression in bone marrow cells in aldehyde dehydrogenase 2-disrupted mice. Bone. 2011;48:1075–86.CrossRefPubMedGoogle Scholar
  33. 33.
    Callaci JJ, Himes R, Lauing K, et al. Binge alcohol-induced bone damage is accompanied by differential expression of bone remodeling-related genes in rat vertebral bone. Calcif Tissue Int. 2009;84:474–84.Google Scholar
  34. 34.
    Elmali N, Ertem K, Ozen S, et al. Fracture healing and bone mass in rats fed on liquid diet containing ethanol. Alcohol Clin Exp Res. 2002;26:509–13.CrossRefPubMedGoogle Scholar
  35. 35.
    Chakkalakal DA, Novak JR, Fritz ED, et al. Chronic ethanol consumption results in deficient bone repair in rats. Alcohol Alcohol. 2002;37:13–20.CrossRefPubMedGoogle Scholar
  36. 36.
    Chakkalakal DA, Novak JR, Fritz ED, et al. Inhibition of bone repair in a rat model for chronic and excessive alcohol consumption. Alcohol. 2005;36:201–14.CrossRefPubMedGoogle Scholar
  37. 37.
    Shankar K, Hidestrand M, Liu X, et al. Chronic ethanol consumption inhibits postlactational anabolic bone rebuilding in female rats. J Bone Miner Res. 2008;23:338–49.CrossRefPubMedGoogle Scholar
  38. 38.
    Malik P, Gasser RW, Kemmler G, et al. Low bone mineral density and impaired bone metabolism in young alcoholic patients without liver cirrhosis: a cross-sectional study. Alcohol Clin Exp Res. 2009;33:375–81.CrossRefPubMedGoogle Scholar
  39. 39.
    Nelson RE, Nebeker JR, Sauer BC, Lafleur J. Factors associated with screening or treatment initiation among male United States veterans at risk for osteoporosis fracture. Bone. 2012;50:983–8. doi:10.1016/j.bone.2011.11.014.CrossRefPubMedGoogle Scholar
  40. 40.
    Malik P. Alkoholinduzierte Reaktion der Knochenmineraldichte: eine Übersicht. J Miner Stoffwechs. 2008;15:123–8.Google Scholar
  41. 41.
    Duggan SN, O’Sullivan M, Hamilton S, et al. Patients with chronic pancreatitis are at increased risk for osteoporosis. Pancreas. 2012;41:1119–24. doi:10.1097/MPA.0b013e31824abb4d.CrossRefPubMedGoogle Scholar
  42. 42.
    Laitinen K, Välimäki M, Lamberg-Allardt C, et al. Deranged vitamin D metabolism but normal bone mineral density in Finnish noncirrhotic male alcoholics. Alcohol Clin Exp Res. 1990;14:551–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Carey EJ, Balan V, Kremers WK, et al. Osteopenia and osteoporosis in patients with end stage liver disease caused by hepatitis C and alcoholic liver disease: not just a cholestatic problem. Liver Transpl. 2003;9:1166–73.CrossRefPubMedGoogle Scholar
  44. 44.
    Garcia-Valdecasas-Campelo E, Gonzalez-Reimers E, Santoria-Fernandez F, et al. Serum osteoprotegerin and RANKL levels in chronic alcoholic liver disease. Alcohol Alcohol. 2006;41:261–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Gonzalez-Calvín JL, Garcia-Sanchez A, Bellot V, et al. Mineral metabolism, osteoblastic function and bone mass in chronic alcoholism. Alcohol Alcohol. 1993;28:571–9.PubMedGoogle Scholar
  46. 46.
    Diamond T, Striel D, Lunzer M, et al. Osteoporosis and skeletal fractures in chronic liver disease. Gut. 1990;31:82–7.CrossRefPubMedGoogle Scholar
  47. 47.
    Leslie WD, Bernstein CN, Leboff MS; American Gastroenterological Association Clinical Practice Comitee. AGA technical review on osteoporosis in hepatic disorders. Gastroenterology. 2003;125:941–66.CrossRefPubMedGoogle Scholar
  48. 48.
    Iwaniec UT, Wronski TJ, Turner RT. Histological analysis of bone. Methods Mol Biol. 2008;447:325–41.CrossRefPubMedGoogle Scholar
  49. 49.
    Berg KM, Kunins HV, Jackson JL, et al. Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med. 2008;121:406–18. doi:10.1016/j.amjmed.2007.12.012.PubMedCentralCrossRefPubMedGoogle Scholar
  50. 50.
    Kouda K, Iki M, Fujita Y, et al. Alcohol intake and bone status in elderly Japanese men: baseline data from the Fujiwara-kyo osteoporosis risk in men (FORMEN) study. Bone. 2011;49:275–80.CrossRefPubMedGoogle Scholar
  51. 51.
    González-Reimers E, Alvisa-Negrín J, Santolaria-Fernández F, et al. Prognosis of osteopenia in chronic alcoholics. Alcohol. 2011;45:227–38. doi:10.1016/j.alcohol.2010.09.002.CrossRefPubMedGoogle Scholar
  52. 52.
    Wosje KS, Kalkwarf HJ. Bone density in relation to alcohol intake among men and women in the United States. Osteoporos Int. 2007;18:391–400.CrossRefPubMedGoogle Scholar
  53. 53.
    Laitinen K, Lamberg-Allardt C, Tunninen R, et al. Bone mineral density and abstention-induced changes in bone and mineral metabolism in noncirrhotic male alcoholics. Am J Med. 1992;93:642–50.CrossRefPubMedGoogle Scholar
  54. 54.
    Collier J. Bone disorders in chronic liver disease. Hepatology. 2007; 46:1271–8.CrossRefPubMedGoogle Scholar
  55. 55.
    George J, Ganesh HK, Acharya S, et al. Bone mineral density and disorders of mineral metabolism in chronic liver disease. World J Gastroenterol. 2009;15:3516–22.CrossRefPubMedGoogle Scholar
  56. 56.
    Chen CC, Wang SS, Jeng FS, Lee SD. Metabolic bone disease of liver cirrhosis: is it parallel to the clinical severity of cirrhosis? J Gastroenterol Hepatol. 1996;11:417–21.CrossRefPubMedGoogle Scholar
  57. 57.
    Díez-Ruiz A, García-Saura PL, García-Ruiz P, et al. Bone mineral density, bone turnover markers and cytokines in alcohol-induced cirrhosis. Alcohol Alcohol. 2010; 45:427–30.CrossRefPubMedGoogle Scholar
  58. 58.
    Patri B, Le Charpentier Y, Guéris J, et al. [Vitamin D, parathormone, calcitonin and bone histomorphometry in patients with cirrhosis]. Rev Rhum Mal Osteoartic. 1978;45:631–40.PubMedGoogle Scholar
  59. 59.
    Alvisa-Negrín J, González-Reimers E, Santolaria-Fernández F, et al. Osteopenia in alcoholics: effect of alcohol abstinence. Alcohol Alcohol. 2009;44:468–75.CrossRefPubMedGoogle Scholar
  60. 60.
    Turner RT. Skeletal response to alcohol. Alcohol Clin Exp Res. 2000;24:1693–701.CrossRefPubMedGoogle Scholar
  61. 61.
    Mobarhan SA, Russell RM, Recker RR, et al. Metabolic bone disease in alcoholic cirrhosis: a comparison of the effect of vitamin D2, 25-hydroxyvitamin D, or supportive treatment. Hepatology. 1984;4:266–73.CrossRefPubMedGoogle Scholar
  62. 62.
    Monegal A, Navasa M, Guañabens N, et al. Osteoporosis and bone mineral metabolism disorders in cirrhotic patients referred for orthotopic liver transplantation. Calcif Tissue Int. 1997;60:148–54.CrossRefPubMedGoogle Scholar
  63. 63.
    Hippisley Cox J, Coupland C. Predicting risk of osteoporotic fractures in men and women in England and Wales: prospective derivation and validation of QFracture Scores. BMJ. 2009;339:b4229.Google Scholar
  64. 64.
    Mikosch P, Hughes D. An overview on bone manifestations in Gaucher disease. Wien Med Wochenschr. 2010;160:609–24. doi:10.1007/s10354-010-0841-y.CrossRefPubMedGoogle Scholar
  65. 65.
    Roach R, Miller D, Driffiths D. Multifocal osteonecrosis predominantly affecting the knees secondary to chronic alcohol ingestion: a case report and review. Acta Orthop Belg. 2006;72:234–6.PubMedGoogle Scholar
  66. 66.
    Shigemura T, Nakamura J, Kishida S, et al. The incidence of alcohol-associated osteonecrosis of the knee is lower than the incidence of steroid-associated osteonecrosis of the knee: an MRI study. Rheumatology (Oxford). 2012;51:701–6. doi:10.1093/rheumatology/ker426.CrossRefGoogle Scholar
  67. 67.
    Weinstein RS, Nicholas RW, Manolagas SC. Apoptosis of osteocytes in glucocorticoid-induced ostenecrosis of the hip. J Clin Endocrinol Metab. 2000;85:2907–12.PubMedGoogle Scholar
  68. 68.
    Kuga Y. Factors associated with osteonecrosis in the femoral head in chronic alcoholism. Kurume Med J. 2000;47:147–9.CrossRefPubMedGoogle Scholar
  69. 69.
    Delling G. Pathophysiology of femoral head necrosis. Orthopade. 2007;36:404, 406–8, 410–3.CrossRefPubMedGoogle Scholar
  70. 70.
    Kang JS, Park S, Song JH, et al. Prevalence of osteonecrosis of the femoral head: a nationwide epidemiological analysis in Korea. J Arthroplasty. 2009;24:1178–83. doi:10.1016/j.arth.2009.05.022.CrossRefPubMedGoogle Scholar
  71. 71.
    Kukushima W, Fujioka M, Kubo T, et al. Nationwide epidemiologic survey of idiopathic osteonecrosis of the femoral head. Clin Orthop Relat Res. 2010;468:2715–24. doi:10.1007/s11999-010-1292-x.CrossRefGoogle Scholar
  72. 72.
    Iwaniec UT, Trevisiol CH, Maddalozzo GF, et al. Effects of low-dose parathyroid hormone on bone mass, turnover, and ectopic osteoinduction in a rat model for chronic alcohol abuse. Bone. 2008;42:695–701. doi:10.1016/j.bone.2007.12.221.PubMedCentralCrossRefPubMedGoogle Scholar
  73. 73.
    Tucker KL, 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. 2009;89:1188–96.CrossRefPubMedGoogle Scholar
  74. 74.
    Williams FM, Cherkas LF, Spector TD, MacGregor AJ. The effect of moderate alcohol consumption on bone mineral density: a study of female twins. Ann Rheum Dis. 2005;64:309–10.CrossRefPubMedGoogle Scholar
  75. 75.
    Meadows ES, Mitchell BD, Bolge SC, et al. Factors associated with treatment of women with osteoporosis or osteopenia from a national survey. BMC Womens Health. 2012;12:1. doi:10.1186/1472-6874-12-1.PubMedCentralCrossRefPubMedGoogle Scholar
  76. 76.
    Wezeman FH, Emanuele MA, Moskal SF, et al. Alendronate administration and skeletal response during chronic alcohol intake in the adolescent male rat. J Bone Miner Res. 2000;15:2033–41.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  1. 1.Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling,1st Medical DepartmentHanusch HospitalViennaAustria

Personalised recommendations