Skip to main content
SpringerLink
Log in

Association between alcohol intake and bone mineral density: results from the NHANES 2005–2020 and two-sample Mendelian randomization

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

We used the data from the NHANES cross-sectional study among 14,113 participants and indicated a positive correlation between alcohol intake frequency and bone mineral density in different body sites. Mendelian randomization was conducted, and no causal relationship is significant between these two variables. The study can provide some suggestions on the daily consumption of alcohol for osteoporosis patients.

Purpose

The effect of alcohol intake on bone mineral density (BMD) remains unclear. This study explored the association and causality between alcohol intake and BMD.

Methods

Based on the 2005–2020 National Health and Nutrition Examination Survey including 14,113 participants, we conducted co-variate-adjusted multilinear regression analyses to explore the association between alcohol intake levels and spine or femur BMD. To evaluate the causal association between alcohol intake frequency and bone mineral density, the inverse variance weighted approach of two-sample Mendelian randomization (MR) was used with genetic data from the Medical Research Council Integrative Epidemiology Unit (462,346 cases) for alcohol intake frequency and the Genetic Factors for Osteoporosis Consortium (28,496 cases) for lumbar spine and femur neck BMD (32,735 cases).

Results

Compared with non-drinkers, total femur BMDs but not total spine BMD increased with daily alcohol intake in males (β = 3.63*10–2 for mild drinkers, β = 4.21*10–2 for moderate drinkers, and β = 4.26*10–2 for heavy drinkers). By contrast, the higher total spine BMD in females was related to higher alcohol intake levels (β = 2.15*10–2 for mild drinkers, β = 2.59*10–2 for moderate drinkers, and β = 3.88*10–2 for heavy drinkers). Regarding the two-sample MR results, no causal relationship was observed between alcohol intake frequency and lumbar spine BMD (odds ratio [OR] = 1.016, P = 0.789) or femur neck BMD (OR = 1.048, P = 0.333).

Conclusion

This study suggests a positive association between alcohol intake frequency and BMD, although the causal relationship was not significant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Armas LA, Recker RR (2012) Pathophysiology of osteoporosis: new mechanistic insights. Endocrinol Metab Clin North Am 41:475–486. https://doi.org/10.1016/j.ecl.2012.04.006

    Article  CAS  PubMed  Google Scholar 

  2. Nelson HD, Haney EM, Dana T, Bougatsos T, Chou R (2010) Screening for osteoporosis: an update for the U.S. Preventive Services Task Force. Ann Intern Med 153:99–111. https://doi.org/10.7326/0003-4819-153-2-201007200-00262

    Article  PubMed  Google Scholar 

  3. Ensrud KE, Crandall CJ (2017) Osteoporosis. Ann Intern Med 67:ITC17–ITC32. https://doi.org/10.7326/AITC201708010

    Article  Google Scholar 

  4. Jiang C, Giger ML, Kwak SM, Chinander MR, Martell JM, Favus MJ (2000) Normalized BMD as a predictor of bone strength. Acad Radiol 7:33–39. https://doi.org/10.1016/s1076-6332(00)80441-9

    Article  CAS  PubMed  Google Scholar 

  5. Pluijm SM, Visser M, Smit JH, Popp-Snijders C, Roos JC, Lips P (2001) Determinants of bone mineral density in older men and women: body composition as mediator. J Bone Miner Res 16:2142–2151. https://doi.org/10.1359/jbmr.2001.16.11.2142

    Article  CAS  PubMed  Google Scholar 

  6. Shore RM, Langman CB, Donovan JM, Conway JJ, Poznanski AK (1995) Bone mineral disorders in children: evaluation with dual x-ray absorptiometry. Radiology 196:535–540. https://doi.org/10.1148/radiology.196.2.7617873

    Article  CAS  PubMed  Google Scholar 

  7. Cavedon V, Milanese C, Laginestra FG, Giuriato G, Pedrinolla A, Ruzzante F et al (2020) Bone and skeletal muscle chang-es in oldest-old women: the role of physical inactivity. Aging Clin Exp Res 32:207–214. https://doi.org/10.1007/s40520-019-01352-x

    Article  PubMed  Google Scholar 

  8. Fabiani R, Naldini G, Chiavarini M (2019) Dietary patterns in relation to low bone mineral density and fracture risk: a sys-tematic review and meta-analysis. Adv Nutr 10:219–236. https://doi.org/10.1093/advances/nmy073

    Article  PubMed  PubMed Central  Google Scholar 

  9. Frenkel B, White W, Tuckermann J (2015) Glucocorticoid-induced osteoporosis. Adv Exp Med Biol 872:179–215. https://doi.org/10.1007/978-1-4939-2895-8_8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Huang AJ, Ettinger B, Vittinghoff E, Ensrud KE, Johnson KC, Cummings SR (2007) Endogenous estrogen levels and the ef-fects of ultra-low-dose transdermal estradiol therapy on bone turnover and BMD in postmenopausal women. J Bone Miner Res 22:1791–1797. https://doi.org/10.1359/jbmr.070707

    Article  CAS  PubMed  Google Scholar 

  11. Napoli N, Chandran M, Pierroz DD, Abrahamsen B, Schwartz AV, Ferrari SL et al (2017) Mechanisms of diabetes mellitus-induced bone fragility. Nat Rev Endocrinol 13:208–219. https://doi.org/10.1038/nrendo.2016.153

    Article  CAS  PubMed  Google Scholar 

  12. Walsh JS, Vilaca T (2017) Obesity, type 2 diabetes and bone in adults. Calcif Tissue Int 100:528–535. https://doi.org/10.1007/s00223-016-0229-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. World Health Organization (2018) Global status report on alcohol and health. In: Poznyak V, Rekve D (eds) Alcohol, drugs and addictive behaviors (ADA), pp 450. https://www.who.int/publications/i/item/9789241565639

  14. Barbosa C, Cowell AJ, Dowd WN (2021) Alcohol consumption in response to the COVID-19 pandemic in the United States. J Addict Med 15:341–344. https://doi.org/10.1097/ADM.0000000000000767

    Article  CAS  PubMed  Google Scholar 

  15. Kouda K, Iki M, Fujita Y, Tamaki J, Yura A, Kadowaki E et al (2011) Alcohol intake and bone status in elderly Japanese men: baseline data from the Fujiwara-kyo osteoporosis risk in men (FORMEN) study. Bone 49:275–280. https://doi.org/10.1016/j.bone.2011.04.010

    Article  CAS  PubMed  Google Scholar 

  16. Malik P, Gasser RW, Kemmler G, Moncayo R, Finkenstedt G, Kurz M et al (2009) Low bone mineral density and im-paired bone metabolism in young alcoholic patients without liver cirrhosis: a cross-sectional study. Alcohol Clin Exp Res 33:375–381. https://doi.org/10.1111/j.1530-0277.2008.00847.x

    Article  CAS  PubMed  Google Scholar 

  17. Kim MJ, Shim MS, Kim MK, Lee Y, Shin YG, Chung CH et al (2003) Effect of chronic alcohol ingestion on bone mineral density in males without liver cirrhosis. Korean J Intern Med 18:174–180. https://doi.org/10.3904/kjim.2003.18.3.174

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Sommer S, Erkkilä AT, Järvinen R, Mursu J, Sirola J, Jurvelin JS et al (2013) Alcohol consumption and bone mineral den-sity in elderly women. Public Health Nutr 16:704–712. https://doi.org/10.1017/S136898001200331X

    Article  PubMed  Google Scholar 

  19. Godos J, Giampieri F, Chisari E, Micek A, Paladino N, Forbes-Hernández TY et al (2022) Alcohol consumption, bone min-eral density, and risk of osteoporotic fractures: a dose-response meta-analysis. Int J Environ Res Public Health 19:1515. https://doi.org/10.3390/ijerph19031515

    Article  PubMed  PubMed Central  Google Scholar 

  20. Jang HD, Hong JY, Han K, Lee JC, Shin BJ, Choi SW et al (2017) Relationship between bone mineral density and alcohol intake: a nationwide health survey analysis of postmenopausal women. PLoS ONE 12:e0180132. https://doi.org/10.1371/journal.pone.0180132

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Felson DT, Zhang Y, Hannan MT, Kannel WB, Kiel DP (1995) Alcohol intake and bone mineral density in elderly men and women. The Framingham study. Am J Epidemiol 142:485–492. https://doi.org/10.1093/oxfordjournals.aje.a117664

    Article  CAS  PubMed  Google Scholar 

  22. Feskanich D, Korrick SA, Greenspan SL, Rosen HN, Colditz GA (1999) Moderate alcohol consumption and bone density among postmenopausal women. J Womens Health 8:65–73. https://doi.org/10.1089/jwh.1999.8.65

    Article  CAS  PubMed  Google Scholar 

  23. Tivis LJ, Tivis RD (2008) One-per-occasion or less: are moderate-drinking postmenopausal women really healthier than their nondrinking and heavier-drinking peers? Alcohol Clin Exp Res 32:1670–1680. https://doi.org/10.1111/j.1530-0277.2008.00744.x

    Article  PubMed  PubMed Central  Google Scholar 

  24. MacInnis RJ, Cassar C, Nowson CA, Paton LM, Flicker L, Hopper JL et al (2003) Determinants of bone density in 30- to 65-year-old women: a co-twin study. J Bone Miner Res 18:1650–1656. https://doi.org/10.1359/jbmr.2003.18.9.1650

    Article  CAS  PubMed  Google Scholar 

  25. Hansen MA, Overgaard K, Riis BJ, Christiansen C (1991) Potential risk factors for development of postmenopausal osteo-porosis–examined over a 12-year period. Osteoporos Int 1:95–102. https://doi.org/10.1007/BF01880450

    Article  CAS  PubMed  Google Scholar 

  26. Stevenson JC, Lees B, Devenport M, Cust MP, Ganger KF (1989) Determinants of bone density in normal women: risk fac-tors for future osteoporosis? BMJ 298:924–928. https://doi.org/10.1136/bmj.298.6678.924

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. National Center for Health Statistics. Available online: http://www.cdc.gov/nchs/nhanes.htm. Accessed 20 Nov 2022

  28. Rattan P, Penrice DD, Ahn JC, Ferrer A, Patnaik M, Shah VH et al (2022) Inverse association of telomere length with liver disease and mortality in the US population. Hepatol Commun 6:399–410. https://doi.org/10.1002/hep4.1803

    Article  CAS  PubMed  Google Scholar 

  29. Davey Smith G, Hemani G (2014) Mendelian randomization: genetic anchors for causal inference in epidemiological studies. Hum Mol Genet 23:R89-98. https://doi.org/10.1093/hmg/ddu328

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Alcohol intake frequency. Available online: https://gwas.mrcieu.ac.uk/datasets/ukb-b-5779. Accessed 25 Nov 2022

  31. Zheng HF, Forgetta V, Hsu YH, Estrada K, Rosello-Diez A, Leo PJ et al (2015) Whole-genome sequencing identifies EN1 as a determinant of bone density and fracture. Nature 526:112–117. https://doi.org/10.1038/nature14878

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Roerecke M, Rehm J (2014) Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of me-ta-analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers. BMC Med 12:182. https://doi.org/10.1186/s12916-014-0182-6

    Article  PubMed  PubMed Central  Google Scholar 

  33. Edelman EJ, Fiellin DA (2016) In the clinic. Alcohol use. Ann Intern Med 164:ITC1-16. https://doi.org/10.7326/AITC201601050

    Article  PubMed  Google Scholar 

  34. McLernon DJ, Powell JJ, Jugdaohsingh R, Macdonald HM (2012) Do lifestyle choices explain the effect of alcohol on bone mineral density in women around menopause? Am J Clin Nutr 95:1261–1269. https://doi.org/10.3945/ajcn.111.021600

    Article  CAS  PubMed  Google Scholar 

  35. Coulson CE, Williams LJ, Brennan SL, Berk M, Kotowicz MA, Lubman DI et al (2013) Alcohol consumption and body composition in a population-based sample of elderly Australian men. Aging Clin Exp Res 25:183–192. https://doi.org/10.1007/s40520-013-0026-9

    Article  PubMed  Google Scholar 

  36. Marrone JA, Maddalozzo GF, Branscum AJ, Hardin K, Cialdella-Kam L, Philbrick KA et al (2012) Moderate alcohol intake lowers biochemical markers of bone turnover in postmenopausal women. Menopause 19:974–979. https://doi.org/10.1097/gme.0b013e31824ac071

    Article  PubMed  Google Scholar 

  37. Berg KM, Kunins HV, Jackson JL, Nahvi S, Chaudhry A, Harris KA Jr et al (2008) Association between alcohol con-sumption and both osteoporotic fracture and bone density. Am J Med 121:406–418. https://doi.org/10.1016/j.amjmed.2007.12.012

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Diamond T, Stiel D, Lunzer M, Wilkinson M, Posen S (1989) Ethanol reduces bone formation and may cause osteoporosis. Am J Med 86:282–288. https://doi.org/10.1016/0002-9343(89)90297-0

    Article  CAS  PubMed  Google Scholar 

  39. Seo S, Chun S, Newell MA, Yun M (2015) Association between alcohol consumption and Korean young women’s bone health: a cross sectional study from the 2008 to 2011 Korea National Health and Nutrition Examination Survey. BMJ Open 5:e007914. https://doi.org/10.1136/bmjopen-2015-007914

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hyeon JH, Gwak JS, Hong SW, Kwon H, Oh SW, Lee CM (2016) Relationship between bone mineral density and alcohol consumption in Korean men: the Fourth Korea National Health and Nutrition Examination Survey (KNHANES), 2008–2009. Asia Pac J Clin Nutr 25:308–315. https://doi.org/10.6133/apjcn.2016.25.2.17

    Article  CAS  PubMed  Google Scholar 

  41. Maurel DB, Boisseau N, Benhamou CL, Jaffre C (2012) Alcohol and bone: review of dose effects and mechanisms. Osteoporos Int 23:1–16. https://doi.org/10.1007/s00198-011-1787-7

    Article  CAS  PubMed  Google Scholar 

  42. Sripanyakorn S, Jugdaohsingh R, Mander A, Davidson SL, Thompson RP, Powell JJ et al (2009) Moderate ingestion of alcohol is associated with acute ethanol-induced suppression of circulating CTX in a PTH-independent fashion. J Bone Miner Res 24:1380–1388. https://doi.org/10.1359/jbmr.090222

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Rapuri PB, Gallagher JC, Balhorn KE, Ryschon KL (2000) Alcohol intake and bone metabolism in elderly women. Am J Clin Nutr 72:1206–1213. https://doi.org/10.1093/ajcn/72.5.1206

    Article  CAS  PubMed  Google Scholar 

  44. Vantyghem MC, Danel T, Marcelli-Tourvieille S, Moriau J, Leclerc L, Cardot-Bauters C et al (2007) Calcitonin levels do not decrease with weaning in chronic alcoholism. Thyroid 2007(17):213–217. https://doi.org/10.1089/thy.2006.0216

    Article  Google Scholar 

  45. Naot D, Musson DS, Cornish J (2019) The activity of peptides of the calcitonin family in bone. Physiol Rev 99:781–805. https://doi.org/10.1152/physrev.00066.2017

    Article  CAS  PubMed  Google Scholar 

  46. Gavaler JS (2005) Should we consider an acceptable drinking level specifically for postmenopausal women? Preliminary findings from the postmenopausal health disparities study. Alcohol 40:469–473. https://doi.org/10.1093/alcalc/agh173

    Article  Google Scholar 

  47. Jugdaohsingh R, O’Connell MA, Sripanyakorn S, Powell JJ (2006) Moderate alcohol consumption and increased bone mineral density: potential ethanol and non-ethanol mechanisms. Proc Nutr Soc 65:291–310. https://doi.org/10.1079/pns2006508

    Article  CAS  PubMed  Google Scholar 

  48. Reichman ME, Judd JT, Longcope C, Schatzkin A, Clevidence BA, Nair PP et al (1993) Effects of alcohol consumption on plasma and urinary hormone concentrations in premenopausal women. J Natl Cancer Inst 85:722–727. https://doi.org/10.1093/jnci/85.9.722

    Article  CAS  PubMed  Google Scholar 

  49. Nagata C, Kabuto M, Takatsuka N, Shimizu H (1997) Associations of alcohol, height, and reproductive factors with serum hormone concentrations in postmenopausal Japanese women. Steroid hormones in Japanese postmenopausal women. Breast Cancer Res Treat 44:235–41. https://doi.org/10.1023/a:1005831220205

    Article  CAS  PubMed  Google Scholar 

  50. Schneider DL, Barrett-Connor EL, Morton DJ (1994) Thyroid hormone use and bone mineral density in elderly women. Effects of estrogen. JAMA 271:1245–1249

    Article  CAS  PubMed  Google Scholar 

  51. Vandenput L, Ohlsson O (2009) Estrogens as regulators of bone health in men. Nat Rev Endocrinol 5:437–443. https://doi.org/10.1038/nrendo.2009.112

    Article  CAS  PubMed  Google Scholar 

  52. Hoffman AR, Majchrowicz E, Poth MA, Paul SM (1981) Ethanol reduces hepatic estrogen-2-hydroxylase activity in the male rat. Life Sci 29:789–794. https://doi.org/10.1016/0024-3205(81)90034-5

    Article  CAS  PubMed  Google Scholar 

  53. Singletary SW, Frey RS, Yan W (2001) Effect of ethanol on proliferation and estrogen receptor-alpha expression in human breast cancer cells. Cancer Lett 165:131–137. https://doi.org/10.1016/s0304-3835(01)00419-0

    Article  CAS  PubMed  Google Scholar 

  54. Colantoni A, Emanuele MA, Kovacs EJ, Villa E, Van Thiel DH (2002) Hepatic estrogen receptors and alcohol intake. Mol Cell Endocrinol 193:101–104. https://doi.org/10.1016/s0303-7207(02)00102-8

    Article  CAS  PubMed  Google Scholar 

  55. Kutlesa Z, Budimir Mrsic D (2016) Wine and bone health: a review. J Bone Miner Metab 34:11–22. https://doi.org/10.1007/s00774-015-0660-8

    Article  CAS  PubMed  Google Scholar 

  56. Trius-Soler M, Vilas-Franquesa A, Tresserra-Rimbau A, Sasot G, Storniolo CE, Estruch E et al (2020) Effects of the non-alcoholic fraction of beer on abdominal fat, osteoporosis, and body hydration in women. Molecules 25:3910. https://doi.org/10.3390/molecules25173910

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Ference BA, Ray KK, Catapano AL, Ference TB, Burgess S, Neff DR et al (2019) Mendelian randomization study of ACLY and cardiovascular disease. N Engl J Med 380:1033–1042. https://doi.org/10.1056/NEJMoa1806747

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Guo R, Wu L, Fu Q (2018) Is there causal relationship of smoking and alcohol consumption with bone mineral density? A mendelian randomization study. Calcif Tissue Int 103:546–553. https://doi.org/10.1007/s00223-018-0452-y

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study was funded by the Doctoral Innovation Fund for Eight-Year Students of Changzheng Hospital (BSCX2022-21).

Author information

Authors and Affiliations

  1. Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China

    Bowen Lai, Heng Jiang, Rui Gao & Xuhui Zhou

Authors
  1. Bowen Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heng Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rui Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xuhui Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xuhui Zhou.

Ethics declarations

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki, and the NHANES was reviewed and approved by the NCHS Research Ethics Review Board (https://www.cdc.gov/nchs/nhanes/irba98.htm). Additionally, all NHANES data released by the NCHS is de-identified and remained anonymous during data analysis in this study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 386 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lai, B., Jiang, H., Gao, R. et al. Association between alcohol intake and bone mineral density: results from the NHANES 2005–2020 and two-sample Mendelian randomization. Arch Osteoporos 19, 21 (2024). https://doi.org/10.1007/s11657-024-01382-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-024-01382-7

Keywords

Search

Navigation