Skip to main content
Top
Published in: Osteoporosis International 7/2005

01-07-2005 | Original Article

Alcohol intake as a risk factor for fracture

Authors: John A. Kanis, Helena Johansson, Olof Johnell, Anders Oden, Chris De Laet, John A. Eisman, Huibert Pols, Alan Tenenhouse

Published in: Osteoporosis International | Issue 7/2005

Login to get access

Abstract

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.
Literature
1.
go back to reference Seeman E, Melton LJ III, O’Fallon WM, Riggs BL (1983) Risk factors for spinal osteoporosis in men. Am J Med 75:977–983CrossRefPubMed Seeman E, Melton LJ III, O’Fallon WM, Riggs BL (1983) Risk factors for spinal osteoporosis in men. Am J Med 75:977–983CrossRefPubMed
2.
go back to reference Holbrook TL, Barrett-Connor E (1993) A prospective study of alcohol consumption and bone mineral density. BMJ 306:1506–1509PubMed Holbrook TL, Barrett-Connor E (1993) A prospective study of alcohol consumption and bone mineral density. BMJ 306:1506–1509PubMed
3.
go back to reference Johnell O, Kristenson H, Redlund-Johnell I (1985) Lower limb fractures and the registration for alcoholism. Scand J Soc Med 13:95–97PubMed Johnell O, Kristenson H, Redlund-Johnell I (1985) Lower limb fractures and the registration for alcoholism. Scand J Soc Med 13:95–97PubMed
4.
go back to reference Felson DT, Zhang Y, Hannan MT et al (1995) Alcohol intake and bone mineral density in elderly men and women. The Framingham Study. Am J Epidemiol 142:485–492PubMed Felson DT, Zhang Y, Hannan MT et al (1995) Alcohol intake and bone mineral density in elderly men and women. The Framingham Study. Am J Epidemiol 142:485–492PubMed
5.
go back to reference Orwoll ES, Bevan L, Phipps KR (2000) Determinants of bone mineral density in older men. Osteoporos Int 11:815–821CrossRefPubMed Orwoll ES, Bevan L, Phipps KR (2000) Determinants of bone mineral density in older men. Osteoporos Int 11:815–821CrossRefPubMed
6.
go back to reference Hoidrup S, Gronbaek M, Gottschau A, Lauritzen JB, Schroll M and the Copenhagen Centre for Prospective Population Studies (1999) Alcohol intake, beverage preference and risk of hip fracture in men and women. Am J Epidemiol 149:933–1001PubMed Hoidrup S, Gronbaek M, Gottschau A, Lauritzen JB, Schroll M and the Copenhagen Centre for Prospective Population Studies (1999) Alcohol intake, beverage preference and risk of hip fracture in men and women. Am J Epidemiol 149:933–1001PubMed
7.
go back to reference Nguyen TV, Eisman JA, Kelly PJ, Sambrook PN (1996) Risk factors for osteoporotic fractures in elderly men. Am J Epidemiol 144:255–263PubMed Nguyen TV, Eisman JA, Kelly PJ, Sambrook PN (1996) Risk factors for osteoporotic fractures in elderly men. Am J Epidemiol 144:255–263PubMed
8.
go back to reference Tuppurainen M, Kroger H, Honkanen R, Puntila E, Huopio J, Saarikoski S, Alhava E (1995) Risks of perimenopausal fractures: a prospective population based study. Acta Obstet Gynecol Scand 74:624–628PubMed Tuppurainen M, Kroger H, Honkanen R, Puntila E, Huopio J, Saarikoski S, Alhava E (1995) Risks of perimenopausal fractures: a prospective population based study. Acta Obstet Gynecol Scand 74:624–628PubMed
9.
go back to reference Felson DT, Kiel DP, Anderson JJ, Kannel WB (1988) Alcohol consumption and hip fractures: the Framingham Study. Am J Epidemiol 128:1102–1110PubMed Felson DT, Kiel DP, Anderson JJ, Kannel WB (1988) Alcohol consumption and hip fractures: the Framingham Study. Am J Epidemiol 128:1102–1110PubMed
10.
go back to reference Fujiwara S, Kasagi F, Yamada M, Kodama K (1997) Risk factors for hip fracture in a Japanese cohort 12:998–1004 Fujiwara S, Kasagi F, Yamada M, Kodama K (1997) Risk factors for hip fracture in a Japanese cohort 12:998–1004
11.
go back to reference National Osteoporosis Foundation (1998) Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis. Osteoporos Int 8[Suppl 4]:1–88 National Osteoporosis Foundation (1998) Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis. Osteoporos Int 8[Suppl 4]:1–88
12.
go back to reference National Osteoporosis Foundation (1998) Physician’s guide to prevention and treatment of osteoporosis. NOF, Washington DC, pp 1–38 National Osteoporosis Foundation (1998) Physician’s guide to prevention and treatment of osteoporosis. NOF, Washington DC, pp 1–38
13.
go back to reference American College of Rheumatology (2001) Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Ad Hoc Committee on Glucocorticosteroid-Induced Osteoporosis. Arthritis Rheum 44:1496–1503CrossRefPubMed American College of Rheumatology (2001) Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Ad Hoc Committee on Glucocorticosteroid-Induced Osteoporosis. Arthritis Rheum 44:1496–1503CrossRefPubMed
14.
go back to reference Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D on behalf of the EFFO (1997) Guidelines for the diagnosis and management of osteoporosis. Osteoporos Int:7:390–406 Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D on behalf of the EFFO (1997) Guidelines for the diagnosis and management of osteoporosis. Osteoporos Int:7:390–406
15.
go back to reference Royal College of Physicians (1999) Osteoporosis: clinical guidelines for prevention and treatment. RCP, London Royal College of Physicians (1999) Osteoporosis: clinical guidelines for prevention and treatment. RCP, London
16.
go back to reference Royal College of Physicians (2000) Osteoporosis: clinical guidelines for prevention and treatment. Update on pharmacological interventions and an algorithm for management. RCP, London Royal College of Physicians (2000) Osteoporosis: clinical guidelines for prevention and treatment. Update on pharmacological interventions and an algorithm for management. RCP, London
17.
go back to reference Brown JP, Josse RG, for the Scientific Advisory Council of the Osteoporosis Society of Canada (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis. Can Med Ass J 167[Suppl 10]:S1–S34 Brown JP, Josse RG, for the Scientific Advisory Council of the Osteoporosis Society of Canada (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis. Can Med Ass J 167[Suppl 10]:S1–S34
18.
go back to reference European Commission (1998) Report on osteoporosis in the European Community: action on prevention. Luxembourg Office for Official Publications of the European Communities, Luxembourg, p 112 European Commission (1998) Report on osteoporosis in the European Community: action on prevention. Luxembourg Office for Official Publications of the European Communities, Luxembourg, p 112
19.
go back to reference Kreiger N, Tenenhouse A, Joseph L et al (1999) The Canadian Multicenter Osteoporosis Study (CaMos): background, rationale, methods. Can J Aging 18:376–387 Kreiger N, Tenenhouse A, Joseph L et al (1999) The Canadian Multicenter Osteoporosis Study (CaMos): background, rationale, methods. Can J Aging 18:376–387
20.
go back to reference Jones G, Nguyen TV, Sambrook PN, Kelly PJ, Gilbert C, Eisman JA (1994) Symptomatic fracture incidence in elderly men and women. The Dubbo Osteoporosis Epidemiology Study, DOES. Osteoporos Int 4:277–282PubMed Jones G, Nguyen TV, Sambrook PN, Kelly PJ, Gilbert C, Eisman JA (1994) Symptomatic fracture incidence in elderly men and women. The Dubbo Osteoporosis Epidemiology Study, DOES. Osteoporos Int 4:277–282PubMed
21.
go back to reference Hofman A, Grobbee DE, De Jong PT, van den Ouweland FA (1991) Determinants of disease and disability in the elderly: the Rotterdam study. Eur J Epidemiol 7:403–422PubMed Hofman A, Grobbee DE, De Jong PT, van den Ouweland FA (1991) Determinants of disease and disability in the elderly: the Rotterdam study. Eur J Epidemiol 7:403–422PubMed
22.
go back to reference De Laet CEDH, Van Hout BA, Burger H, Hofman A, Weel AEAM, Pols HAP (1998) Hip fracture prediction in elderly men and women: validation of the Rotterdam study. J Bone Miner Res 13:1587–1593PubMed De Laet CEDH, Van Hout BA, Burger H, Hofman A, Weel AEAM, Pols HAP (1998) Hip fracture prediction in elderly men and women: validation of the Rotterdam study. J Bone Miner Res 13:1587–1593PubMed
23.
go back to reference Kanis JA, Oden A, Johnell O, Jonsson B, De Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12:417–427CrossRefPubMed Kanis JA, Oden A, Johnell O, Jonsson B, De Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12:417–427CrossRefPubMed
24.
go back to reference Johnell O, Gullberg B, Kanis JA, Allander E, Elffors L, Dequeker J, Dilsen G, Gennari C, Lopez Vaz A, Lyritis G, Mazzuoli GF, Miravet L, Passeri M, Perez Cano R, Rapado A, Ribot C (1995) Risk factors for hip fracture in European women: the MEDOS study. J Bone Miner Res 10:1802–1815PubMed Johnell O, Gullberg B, Kanis JA, Allander E, Elffors L, Dequeker J, Dilsen G, Gennari C, Lopez Vaz A, Lyritis G, Mazzuoli GF, Miravet L, Passeri M, Perez Cano R, Rapado A, Ribot C (1995) Risk factors for hip fracture in European women: the MEDOS study. J Bone Miner Res 10:1802–1815PubMed
25.
go back to reference Midanik LT (1988) Validity of self-reported alcohol use: a literature review and assessment. Br J Addict 83:1019–1030PubMed Midanik LT (1988) Validity of self-reported alcohol use: a literature review and assessment. Br J Addict 83:1019–1030PubMed
26.
go back to reference Standing Medical Advisory Committee to the Secretaries of State for Health and for Wales (1989) Drinking problems: a challenge for every doctor. HMSO, London Standing Medical Advisory Committee to the Secretaries of State for Health and for Wales (1989) Drinking problems: a challenge for every doctor. HMSO, London
27.
go back to reference La Vecchia C, Negri E, Levi F et al (1991) Cigarette smoking, body mass and other risk factors for fractures of the hip in women. Int J Epidemiol 20:671–677PubMed La Vecchia C, Negri E, Levi F et al (1991) Cigarette smoking, body mass and other risk factors for fractures of the hip in women. Int J Epidemiol 20:671–677PubMed
28.
go back to reference Grisso JA, Kelsey JL, O’Brien LA et al (1997) Risk factors for hip fracture in men. Am J Epidemiol 145:786–793PubMed Grisso JA, Kelsey JL, O’Brien LA et al (1997) Risk factors for hip fracture in men. Am J Epidemiol 145:786–793PubMed
29.
go back to reference Grisso JA, Kelsey JL, Strom BL et al (1991) Risk factors for falls as a cause of hip fracture in women. N Engl J Med 324:1326–1331PubMed Grisso JA, Kelsey JL, Strom BL et al (1991) Risk factors for falls as a cause of hip fracture in women. N Engl J Med 324:1326–1331PubMed
30.
go back to reference Cumming RG, Klineberg RJ (1994) Case-control study of risk factors for hip fractures in the elderly. Am J Epidemiol 139:493–503PubMed Cumming RG, Klineberg RJ (1994) Case-control study of risk factors for hip fractures in the elderly. Am J Epidemiol 139:493–503PubMed
31.
go back to reference Kanis JA, Johnell O, Gullberg B, Allander E, Elffors L, Ranstam J, Dequeker J, Dilsen G, Gennari C, Lopez Vaz A, Lyritis G, Mazzuoli G, Miravet L, Passeri M, Perez Cano R, Rapado A, Ribot C (1999) Risk factors for hip fracture in men from Southern Europe: the MEDOS study. Osteoporos Int 9:45–54CrossRefPubMed Kanis JA, Johnell O, Gullberg B, Allander E, Elffors L, Ranstam J, Dequeker J, Dilsen G, Gennari C, Lopez Vaz A, Lyritis G, Mazzuoli G, Miravet L, Passeri M, Perez Cano R, Rapado A, Ribot C (1999) Risk factors for hip fracture in men from Southern Europe: the MEDOS study. Osteoporos Int 9:45–54CrossRefPubMed
32.
go back to reference Paganini-Hill A, Chao A, Ross RK et al (1991) Exercise and other factors in the prevention of hip fracture: the Leisure World Study. Epidemiology 2:16–25PubMed Paganini-Hill A, Chao A, Ross RK et al (1991) Exercise and other factors in the prevention of hip fracture: the Leisure World Study. Epidemiology 2:16–25PubMed
33.
go back to reference Huang Z, Himes JH, McGovern PG (1996) Nutrition and subsequent hip fracture risk among a national cohort of white women. Am J Epidemiol 144:124–134PubMed Huang Z, Himes JH, McGovern PG (1996) Nutrition and subsequent hip fracture risk among a national cohort of white women. Am J Epidemiol 144:124–134PubMed
34.
go back to reference Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM for the Study of Osteoporotic Fractures Research Group (1995) Risk factors for hip fracture in white women. N Engl J Med 332:767–773CrossRefPubMed Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM for the Study of Osteoporotic Fractures Research Group (1995) Risk factors for hip fracture in white women. N Engl J Med 332:767–773CrossRefPubMed
35.
go back to reference Hemenway D, Azrael DR, Rimm EB, Feskanich D, Willet WC (1994) Risk factors for hip fracture in US men aged 40 through 75 years. Am J Public Health 84:1843–1845PubMed Hemenway D, Azrael DR, Rimm EB, Feskanich D, Willet WC (1994) Risk factors for hip fracture in US men aged 40 through 75 years. Am J Public Health 84:1843–1845PubMed
36.
go back to reference Holbrook TL, Barrett-Connor E, Wingard DL (1988) Dietary calcium and risk of hip fracture: 14-year prospective population study. Lancet 2:1046–1049CrossRefPubMed Holbrook TL, Barrett-Connor E, Wingard DL (1988) Dietary calcium and risk of hip fracture: 14-year prospective population study. Lancet 2:1046–1049CrossRefPubMed
37.
go back to reference Huopio J, Kroger H, Honkanen R, Saarikoski S, Alhava E (2000) Risk factors for perimenopausal fractures: a prospective study. Osteoporos Int 11:219–227CrossRefPubMed Huopio J, Kroger H, Honkanen R, Saarikoski S, Alhava E (2000) Risk factors for perimenopausal fractures: a prospective study. Osteoporos Int 11:219–227CrossRefPubMed
38.
go back to reference Sowers MR, Clark MK, Hollis B, Wallace RB, Jannausch M (1992) Radial bone mineral density in pre- and perimenopausal women: a prospective study of rates and risk factors for loss. J Bone Miner Res 7:647–657PubMed Sowers MR, Clark MK, Hollis B, Wallace RB, Jannausch M (1992) Radial bone mineral density in pre- and perimenopausal women: a prospective study of rates and risk factors for loss. J Bone Miner Res 7:647–657PubMed
39.
go back to reference Roy DK, O’Neill TW, Finn JD et al (2003) Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 14:19–26CrossRefPubMed Roy DK, O’Neill TW, Finn JD et al (2003) Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 14:19–26CrossRefPubMed
40.
go back to reference Laitinen K, Valimaki M (1991) Alcohol and bone. Calcif Tissue Int 49[Suppl]:S70–S73 Laitinen K, Valimaki M (1991) Alcohol and bone. Calcif Tissue Int 49[Suppl]:S70–S73
41.
go back to reference Dymling JF, Ljungberg O, Hillyard CJ, Greenberg PB, Evans IMA, MacIntyre I (1976) Whiskey: a new provocative test for calcitonin secretion. Acta Endocrinol 82:500–509PubMed Dymling JF, Ljungberg O, Hillyard CJ, Greenberg PB, Evans IMA, MacIntyre I (1976) Whiskey: a new provocative test for calcitonin secretion. Acta Endocrinol 82:500–509PubMed
42.
go back to reference Rico H (1990) Alcohol and bone disease. Alcohol 25:345–352 Rico H (1990) Alcohol and bone disease. Alcohol 25:345–352
43.
go back to reference Malmivaara A, Heliovaara M, Knekt P et al (1993) Risk factors for injurious falls leading to hospitalisation or death in a cohort of 19,500 adults. Am J Epidemiol 138:384–394PubMed Malmivaara A, Heliovaara M, Knekt P et al (1993) Risk factors for injurious falls leading to hospitalisation or death in a cohort of 19,500 adults. Am J Epidemiol 138:384–394PubMed
44.
go back to reference Gunnes M, Mellstrom D, Johnell O (1998) How well can a previous fracture indicate a new fracture? A questionnaire study of 29,802 postmenopausal women. Acta Orthop Scand 69:508–512PubMed Gunnes M, Mellstrom D, Johnell O (1998) How well can a previous fracture indicate a new fracture? A questionnaire study of 29,802 postmenopausal women. Acta Orthop Scand 69:508–512PubMed
45.
go back to reference Ensrud KE, Nevitt MC, Yunis C, Cauley JA, Seeley DG, Fox KM et al (1994) Correlates of impaired function in older women. J Am Geriatr Soc 42:481–489PubMed Ensrud KE, Nevitt MC, Yunis C, Cauley JA, Seeley DG, Fox KM et al (1994) Correlates of impaired function in older women. J Am Geriatr Soc 42:481–489PubMed
46.
go back to reference Nelson HD, Nevitt ME, Scott JC, Stone KL, Cummings SR (1994) Smoking, alcohol and neuromuscular and physical function of older women. JAMA 272:1825–1831CrossRefPubMed Nelson HD, Nevitt ME, Scott JC, Stone KL, Cummings SR (1994) Smoking, alcohol and neuromuscular and physical function of older women. JAMA 272:1825–1831CrossRefPubMed
47.
48.
go back to reference Delmas PD, Eastell R, Garnero P, Seibel MJ, Stepan J (2000) The use of biochemical markers of bone turnover in osteoporosis. Osteoporos Int 11[Suppl 6]:S2–S17 Delmas PD, Eastell R, Garnero P, Seibel MJ, Stepan J (2000) The use of biochemical markers of bone turnover in osteoporosis. Osteoporos Int 11[Suppl 6]:S2–S17
49.
go back to reference Guidelines Writing Group (2002) Glucocorticoid-induced osteoporosis: guidelines for prevention and treatment. Bone and Tooth Society of Great Britain, National Osteoporosis Society, and Royal College of Physicians. RCP, London Guidelines Writing Group (2002) Glucocorticoid-induced osteoporosis: guidelines for prevention and treatment. Bone and Tooth Society of Great Britain, National Osteoporosis Society, and Royal College of Physicians. RCP, London
50.
go back to reference Klotzbeucher CM, Ross PD, Landsman PB, Abbot TA, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. JBMR 15:721–739 Klotzbeucher CM, Ross PD, Landsman PB, Abbot TA, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. JBMR 15:721–739
51.
go back to reference Van Staa TP, Leufkens HGM, Cooper C (2002) Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 13:624–629CrossRefPubMed Van Staa TP, Leufkens HGM, Cooper C (2002) Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 13:624–629CrossRefPubMed
Metadata
Title
Alcohol intake as a risk factor for fracture
Authors
John A. Kanis
Helena Johansson
Olof Johnell
Anders Oden
Chris De Laet
John A. Eisman
Huibert Pols
Alan Tenenhouse
Publication date
01-07-2005
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 7/2005
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-004-1734-y

Other articles of this Issue 7/2005

Osteoporosis International 7/2005 Go to the issue