EFFECT OF ALCOHOL ON BONE FRAGILITY
Keywords:
Keywords: alcohol, bone fragility, bone remodeling.
Abstract
Excessive alcohol consumption is a risk factor for over 200 different diseases, including changes in bone remodeling. It is known that 30% of alcoholics who do not have liver cirrhosis have osteoporosis, and that 36% of them have radiologically proven pathological fractures of the spinal vertebrae. This publication presents an overview of modern literature on the mechanisms of alcohol's effects on bone, depending on the type and amount of alcohol. Various cellular and molecular mechanisms are considered responsible for the osteotoxicity of alcohol, including a direct effect on osteoblasts and osteoclasts, as well as altered osteo-adipogenic differentiation of bone marrow mesenchymal stem cells. The effect of alcohol on bone is regulated by Wnt and mTOR pathways. In addition, systemic changes such as hormone homeostasis, oxidative stress, but also altered parathyroid hormone (PTH) - vitamin D and growth hormone - insulin-like growth hormone (IGF) axes have indirect effects on bone cells. Long-term excessive alcohol consumption reduces the absorption of nutrients, testosterone synthesis and the ability of stem cells to differentiate into cells of the osteogenic lineage, which results in a decrease in the activity and level of osteoblastic differentiation while simultaneously increasing osteoclastogenesis. However, particularly controversial are the data of numerous studies that confirm that light to moderate alcohol consumption has a positive effect on bone structure, and that the primary mechanism leading to improvement in bone mineral density is suppression of bone resorption. What still remains unclear is the more precise determination of the amount and type of alcoholic drink that has a benefit on bones, and when toxicity begins to manifest itself, with a consequent decrease in bone mineral density. Therefore, it is necessary to carry out further tests in order to start therapy in a timely manner and prevent pathological bone fractures.
References
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28. Haber PS, Kortt NC. Alcohol use disorder and the gut. Addiction. 2021; 116(3):658–67.
29. Looker AC, Sarafrazi Isfahani N, Fan B, Shepherd JA. FRAX-based Estimates of 10-year Probability of Hip and Major Osteoporotic Fracture Among Adults Aged 40 and Over: United States, 2013 and 2014. Natl Health Stat Report. 2017; (103):1–16.
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32. Monroe DG, Getz BJ, Johnsen SA, Riggs BL, Khosla S, Spelsberg TC. Estrogen receptor isoform-specific regulation of endogenous gene expression in human osteoblastic cell lines expressing either ERalpha or ERbeta. J Cell Biochem. 2003; 90(2):315–26.
33. Syed F, Khosla S. Mechanisms of sex steroid effects on bone. Biochem Biophys Res Commun. 2005; 328(3):688–96.
34. Turner RT. Skeletal Response to Alcohol. Alcoholism Clin Exp Res. 2000; 24(11):1693–701.
35. Bai X chun, Lu D, Liu A ling, Zhang Z ming, Li X mei, Zou Z peng, et al. Reactive oxygen species stimulates receptor activator of NF-kappaB ligand expression in osteoblast. J Biol Chem. 2005; 280(17):17497–506.
36. McLernon DJ, Powell JJ, Jugdaohsingh R, Macdonald HM. Do lifestyle choices explain the effect of alcohol on bone mineral density in women around menopause? Am J Clin Nutr. 2012; 95(5):1261–9.
37. Ilich JZ, Brownbill RA, Tamborini L, Crncevic-Orlic Z. To drink or not to drink: how are alcohol, caffeine and past smoking related to bone mineral density in elderly women? J Am Coll Nutr. 2002; 21(6):536–44.
38. Kouda K, Iki M, Fujita Y, Tamaki J, Yura A, Kadowaki E, 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(2):275–80.
39. Chen JR, Lazarenko OP, Shankar K, Blackburn ML, Badger TM, Ronis MJ. A role for ethanol-induced oxidative stress in controlling lineage commitment of mesenchymal stromal cells through inhibition of Wnt/beta-catenin signaling. J Bone Miner Res. 2010; 25(5):1117–27.
40. Pedrera-Zamorano JD, Lavado-Garcia JM, Roncero-Martin R, Calderon-Garcia JF, Rodriguez-Dominguez T, Canal-Macias ML. Effect of beer drinking on ultrasound bone mass in women. Nutrition. 2009; 25(10):1057–63.
41. Duggal S, Simpson ME, Keiver K. Effect of chronic ethanol consumption on the response of parathyroid hormone to hypocalcemia in the pregnant rat. Alcohol Clin Exp Res. 2007; 31(1):104–12.
42. Rapuri PB, Gallagher JC, Balhorn KE, Ryschon KL. Alcohol intake and bone metabolism in elderly women. Am J Clin Nutr. 2000; 72(5):1206–13.
43. Lombardi G, Di Somma C, Rubino M, Faggiano A, Vuolo L, Guerra E, et al. The roles of parathyroid hormone in bone remodeling: prospects for novel therapeutics. J Endocrinol Invest. 2011; 34(7):18–22.
44. Kizilgul M, Ozcelik O, Delibasi T. Bone health and vitamin D status in alcoholic liver disease. Indian J Gastroenterol. 2016; 35(4):253–9.
45. Anderson PH, Sawyer RK, Moore AJ, May BK, O’Loughlin PD, Morris HA. Vitamin D depletion induces RANKL-mediated osteoclastogenesis and bone loss in a rodent model. J Bone Miner Res. 2008; 23(11):1789–97.
46. Maddalozzo GF, Turner RT, Edwards CHT, Howe KS, Widrick JJ, Rosen CJ, et al. Alcohol alters whole body composition, inhibits bone formation, and increases bone marrow adiposity in rats. Osteoporos Int. 2009; 20(9):1529–38.
47. Menagh PJ, Turner RT, Jump DB, Wong CP, Lowry MB, Yakar S, et al. Growth hormone regulates the balance between bone formation and bone marrow adiposity. J Bone Miner Res. 2010; 25(4):757–68.
48. Lang CH, Vary TC, Frost RA. Acute in vivo elevation of insulin-like growth factor (IGF) binding protein-1 decreases plasma free IGF-I and muscle protein synthesis. Endocrinology. 2003; 144(9):3922–33.
49. Kumar V, Frost RA, Lang CH. Alcohol impairs insulin and IGF-I stimulation of S6K1 but not 4E-BP1 in skeletal muscle. Am J Physiol Endocrinol Metab. 2002; 283(5):E917-28.
50. Ronis MJJ, Wands JR, Badger TM, de la Monte SM, Lang CH, Calissendorff J. Alcohol-induced disruption of endocrine signaling. Alcohol Clin Exp Res. 2007; 31(8):1269–85.
51. Marrone JA, Maddalozzo GF, Branscum AJ, Hardin K, Cialdella-Kam L, Philbrick KA, et al. Moderate alcohol intake lowers biochemical markers of bone turnover in postmenopausal women. Menopause. 2012; 19(9):974–9.
52. Sripanyakorn S, Jugdaohsingh R, Mander A, Davidson SL, Thompson RP, Powell JJ. Moderate ingestion of alcohol is associated with acute ethanol-induced suppression of circulating CTX in a PTH-independent fashion. J Bone Miner Res. 2009; 24(8):1380–8.
53. Filaire E, Toumi H. Reactive oxygen species and exercise on bone metabolism: friend or enemy? Joint Bone Spine. 2012; 79(4):341–6.
54. Berg KM, Kunins HV, Jackson JL, Nahvi S, Chaudhry A, Harris KA, et al. Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med. 2008; 121(5):406–18.
55. Zhang X, Yu Z, Yu M, Qu X. Alcohol consumption and hip fracture risk. Osteoporos Int. 2015; 26(2):531–42.
56. Ganry O, Baudoin C, Fardellone P. Effect of alcohol intake on bone mineral density in elderly women: The EPIDOS Study. Epidémiologie de l’Ostéoporose. Am J Epidemiol. 2000; 151(8):773–80.
57. Cui Q, Wang Y, Saleh KJ, Wang GJ, Balian G. Alcohol-induced adipogenesis in a cloned bone-marrow stem cell. J Bone Joint Surg Am. 2006; 88(3):148–54.
58. Maurel DB, Jaffre C, Rochefort GY, Aveline PC, Boisseau N, Uzbekov R, et al. Low bone accrual is associated with osteocyte apoptosis in alcohol-induced osteopenia. Bone. 2011; 49(3):543–52.
59. Chakkalakal DA. Alcohol-Induced Bone Loss and Deficient Bone Repair: Alcoholism: Clinical & Experimental Research. 2005; 29(12):2077–90.
2. GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018; 392(10152):1015–35.
3. Seitz HK, Neuman MG. The History of Alcoholic Liver Disease: From an Unrecognized Disease to One of the Most Frequent Diseases in Hepatology. J Clin Med. 2021; 10(4):858.
4. Lalor BC, France MW, Powell D, Adams PH, Counihan TB. Bone and mineral metabolism and chronic alcohol abuse. Q J Med. 1986; 59(229):497–511.
5. Sànchez-Riera L, Carnahan E, Vos T, Veerman L, Norman R, Lim SS, et al. The global burden attributable to low bone mineral density. Ann Rheum Dis. 2014; 73(9):1635–45.
6. Godos J, Giampieri F, Chisari E, Micek A, Paladino N, Forbes-Hernández TY, et al. Alcohol Consumption, Bone Mineral Density, and Risk of Osteoporotic Fractures: A Dose-Response Meta-Analysis. Int J Environ Res Public Health. 2022; 19(3):1515.
7. Jin J. Screening for Osteoporosis to Prevent Fractures. JAMA. 2018; 319(24):2566.
8. Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, et al. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int. 2011; 22(5):1277–88.
9. Peris P, Guañabens N, Parés A, Pons F, del Rio L, Monegal A, et al. Vertebral fractures and osteopenia in chronic alcoholic patients. Calcif Tissue Int. 1995; 57(2):111–4.
10. Peris P, Parés A, Guañabens N, Del Río L, Pons F, Martínez de Osaba MJ, et al. Bone mass improves in alcoholics after 2 years of abstinence. J Bone Miner Res. 1994; 9(10):1607–12.
11. Poli A, Marangoni F, Avogaro A, Barba G, Bellentani S, Bucci M, et al. Moderate alcohol use and health: a consensus document. Nutr Metab Cardiovasc Dis. 2013; 23(6):487–504.
12. Phillips JA. Dietary Guidelines for Americans, 2020-2025. Workplace Health Saf. 2021; 69(8):395.
13. de Gaetano G, Costanzo S, Di Castelnuovo A, Badimon L, Bejko D, Alkerwi A, et al. Effects of moderate beer consumption on health and disease: A consensus document. Nutr Metab Cardiovasc Dis. 2016; 26(6):443–67.
14. Vieira BA, Luft VC, Schmidt MI, Chambless LE, Chor D, Barreto SM, et al. Timing and Type of Alcohol Consumption and the Metabolic Syndrome - ELSA-Brasil. PLoS One. 2016; 11(9):e0163044.
15. Liu Y, Kou X, Chen C, Yu W, Su Y, Kim Y, et al. Chronic High Dose Alcohol Induces Osteopenia via Activation of mTOR Signaling in Bone Marrow Mesenchymal Stem Cells. Stem Cells. 2016; 34(8):2157–68.
16. Luo Z, Liu Y, Liu Y, Chen H, Shi S, Liu Y. Cellular and molecular mechanisms of alcohol-induced osteopenia. Cell Mol Life Sci. 2017; 74(24):4443–53.
17. Turner RT, Sibonga JD. Effects of alcohol use and estrogen on bone. Alcohol Res Health. 2001; 25(4):276–81.
18. Dai J, Lin D, Zhang J, Habib P, Smith P, Murtha J, et al. Chronic alcohol ingestion induces osteoclastogenesis and bone loss through IL-6 in mice. J Clin Invest. 2000; 106(7):887–95.
19. Howe KS, Iwaniec UT, Turner RT. The effects of low dose parathyroid hormone on lumbar vertebrae in a rat model for chronic alcohol abuse. Osteoporos Int. 2011; 22(4):1175–81.
20. Wezeman FH, Gong Z. Bone marrow triglyceride accumulation and hormonal changes during long-term alcohol intake in male and female rats. Alcohol Clin Exp Res. 2001; 25(10):1515–22.
21. Liu J, Xiao Q, Xiao J, Niu C, Li Y, Zhang X, et al. Wnt/β-catenin signalling: function, biological mechanisms, and therapeutic opportunities. Signal Transduct Target Ther. 2022; 7(1):3.
22. Gaddini GW, Turner RT, Grant KA, Iwaniec UT. Alcohol: A Simple Nutrient with Complex Actions on Bone in the Adult Skeleton. Alcohol Clin Exp Res. 2016; 40(4):657–71.
23. Jugdaohsingh R, O’Connell MA, Sripanyakorn S, Powell JJ. Moderate alcohol consumption and increased bone mineral density: potential ethanol and non-ethanol mechanisms. Proc Nutr Soc. 2006; 65(3):291–310.
24. López-Larramona G, Lucendo AJ, González-Delgado L. Alcoholic liver disease and changes in bone mineral density. Rev Esp Enferm Dig. 2013; 105(10):609–21.
25. Kutleša Z, Budimir Mršić D. Wine and bone health: a review. J Bone Miner Metab. 2016; 34(1):11–22.
26. Wannenmacher J, Gastl M, Becker T. Phenolic Substances in Beer: Structural Diversity, Reactive Potential and Relevance for Brewing Process and Beer Quality. Compr Rev Food Sci Food Saf. 2018; 17(4):953–88.
27. Trius-Soler M, Vilas-Franquesa A, Tresserra-Rimbau A, Sasot G, Storniolo CE, Estruch R, et al. Effects of the Non-Alcoholic Fraction of Beer on Abdominal Fat, Osteoporosis, and Body Hydration in Women. Molecules. 2020; 25(17):3910.
28. Haber PS, Kortt NC. Alcohol use disorder and the gut. Addiction. 2021; 116(3):658–67.
29. Looker AC, Sarafrazi Isfahani N, Fan B, Shepherd JA. FRAX-based Estimates of 10-year Probability of Hip and Major Osteoporotic Fracture Among Adults Aged 40 and Over: United States, 2013 and 2014. Natl Health Stat Report. 2017; (103):1–16.
30. Substance Abuse and Mental Health Services Administration, Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53) (2018).
31. Chen JR, Haley RL, Hidestrand M, Shankar K, Liu X, Lumpkin CK, et al. Estradiol protects against ethanol-induced bone loss by inhibiting up-regulation of receptor activator of nuclear factor-kappaB ligand in osteoblasts. J Pharmacol Exp Ther. 2006; 319(3):1182–90.
32. Monroe DG, Getz BJ, Johnsen SA, Riggs BL, Khosla S, Spelsberg TC. Estrogen receptor isoform-specific regulation of endogenous gene expression in human osteoblastic cell lines expressing either ERalpha or ERbeta. J Cell Biochem. 2003; 90(2):315–26.
33. Syed F, Khosla S. Mechanisms of sex steroid effects on bone. Biochem Biophys Res Commun. 2005; 328(3):688–96.
34. Turner RT. Skeletal Response to Alcohol. Alcoholism Clin Exp Res. 2000; 24(11):1693–701.
35. Bai X chun, Lu D, Liu A ling, Zhang Z ming, Li X mei, Zou Z peng, et al. Reactive oxygen species stimulates receptor activator of NF-kappaB ligand expression in osteoblast. J Biol Chem. 2005; 280(17):17497–506.
36. McLernon DJ, Powell JJ, Jugdaohsingh R, Macdonald HM. Do lifestyle choices explain the effect of alcohol on bone mineral density in women around menopause? Am J Clin Nutr. 2012; 95(5):1261–9.
37. Ilich JZ, Brownbill RA, Tamborini L, Crncevic-Orlic Z. To drink or not to drink: how are alcohol, caffeine and past smoking related to bone mineral density in elderly women? J Am Coll Nutr. 2002; 21(6):536–44.
38. Kouda K, Iki M, Fujita Y, Tamaki J, Yura A, Kadowaki E, 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(2):275–80.
39. Chen JR, Lazarenko OP, Shankar K, Blackburn ML, Badger TM, Ronis MJ. A role for ethanol-induced oxidative stress in controlling lineage commitment of mesenchymal stromal cells through inhibition of Wnt/beta-catenin signaling. J Bone Miner Res. 2010; 25(5):1117–27.
40. Pedrera-Zamorano JD, Lavado-Garcia JM, Roncero-Martin R, Calderon-Garcia JF, Rodriguez-Dominguez T, Canal-Macias ML. Effect of beer drinking on ultrasound bone mass in women. Nutrition. 2009; 25(10):1057–63.
41. Duggal S, Simpson ME, Keiver K. Effect of chronic ethanol consumption on the response of parathyroid hormone to hypocalcemia in the pregnant rat. Alcohol Clin Exp Res. 2007; 31(1):104–12.
42. Rapuri PB, Gallagher JC, Balhorn KE, Ryschon KL. Alcohol intake and bone metabolism in elderly women. Am J Clin Nutr. 2000; 72(5):1206–13.
43. Lombardi G, Di Somma C, Rubino M, Faggiano A, Vuolo L, Guerra E, et al. The roles of parathyroid hormone in bone remodeling: prospects for novel therapeutics. J Endocrinol Invest. 2011; 34(7):18–22.
44. Kizilgul M, Ozcelik O, Delibasi T. Bone health and vitamin D status in alcoholic liver disease. Indian J Gastroenterol. 2016; 35(4):253–9.
45. Anderson PH, Sawyer RK, Moore AJ, May BK, O’Loughlin PD, Morris HA. Vitamin D depletion induces RANKL-mediated osteoclastogenesis and bone loss in a rodent model. J Bone Miner Res. 2008; 23(11):1789–97.
46. Maddalozzo GF, Turner RT, Edwards CHT, Howe KS, Widrick JJ, Rosen CJ, et al. Alcohol alters whole body composition, inhibits bone formation, and increases bone marrow adiposity in rats. Osteoporos Int. 2009; 20(9):1529–38.
47. Menagh PJ, Turner RT, Jump DB, Wong CP, Lowry MB, Yakar S, et al. Growth hormone regulates the balance between bone formation and bone marrow adiposity. J Bone Miner Res. 2010; 25(4):757–68.
48. Lang CH, Vary TC, Frost RA. Acute in vivo elevation of insulin-like growth factor (IGF) binding protein-1 decreases plasma free IGF-I and muscle protein synthesis. Endocrinology. 2003; 144(9):3922–33.
49. Kumar V, Frost RA, Lang CH. Alcohol impairs insulin and IGF-I stimulation of S6K1 but not 4E-BP1 in skeletal muscle. Am J Physiol Endocrinol Metab. 2002; 283(5):E917-28.
50. Ronis MJJ, Wands JR, Badger TM, de la Monte SM, Lang CH, Calissendorff J. Alcohol-induced disruption of endocrine signaling. Alcohol Clin Exp Res. 2007; 31(8):1269–85.
51. Marrone JA, Maddalozzo GF, Branscum AJ, Hardin K, Cialdella-Kam L, Philbrick KA, et al. Moderate alcohol intake lowers biochemical markers of bone turnover in postmenopausal women. Menopause. 2012; 19(9):974–9.
52. Sripanyakorn S, Jugdaohsingh R, Mander A, Davidson SL, Thompson RP, Powell JJ. Moderate ingestion of alcohol is associated with acute ethanol-induced suppression of circulating CTX in a PTH-independent fashion. J Bone Miner Res. 2009; 24(8):1380–8.
53. Filaire E, Toumi H. Reactive oxygen species and exercise on bone metabolism: friend or enemy? Joint Bone Spine. 2012; 79(4):341–6.
54. Berg KM, Kunins HV, Jackson JL, Nahvi S, Chaudhry A, Harris KA, et al. Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med. 2008; 121(5):406–18.
55. Zhang X, Yu Z, Yu M, Qu X. Alcohol consumption and hip fracture risk. Osteoporos Int. 2015; 26(2):531–42.
56. Ganry O, Baudoin C, Fardellone P. Effect of alcohol intake on bone mineral density in elderly women: The EPIDOS Study. Epidémiologie de l’Ostéoporose. Am J Epidemiol. 2000; 151(8):773–80.
57. Cui Q, Wang Y, Saleh KJ, Wang GJ, Balian G. Alcohol-induced adipogenesis in a cloned bone-marrow stem cell. J Bone Joint Surg Am. 2006; 88(3):148–54.
58. Maurel DB, Jaffre C, Rochefort GY, Aveline PC, Boisseau N, Uzbekov R, et al. Low bone accrual is associated with osteocyte apoptosis in alcohol-induced osteopenia. Bone. 2011; 49(3):543–52.
59. Chakkalakal DA. Alcohol-Induced Bone Loss and Deficient Bone Repair: Alcoholism: Clinical & Experimental Research. 2005; 29(12):2077–90.
Published
2025/07/18
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