Abstract
Excess alcohol consumption is known to be detrimental to human health. However, the role of light-to-moderate alcohol intake is under investigation for potential certain health benefits—mostly related to the cardiovascular system. Nevertheless, there is no univocal agreement on this matter, and research is still ongoing to clarify whether there might be other potential outcomes affected by alcohol intake. In this regard, there is evidence that excess alcohol intake may negatively influence the risk of osteoporotic fractures. However, there is no comprehensive evidence of literature assessing the role of alcohol consumption in bone mineral density (BMD) and the risk of osteoporotic fractures. Thus, the aim of this study was to quantitatively assess the dose–response relationship between alcohol intake and BMD and risk of osteoporotic fractures. The Embase and MEDLINE electronic databases were searched from their inception to December 2021 for articles providing a quantifiable measurement of alcohol consumption for at least three categories and (1) a measurement of BMD (and dispersion as continuous variables) in some area of the body or (2) risk of osteoporotic fracture provided as relative risk (RR) or hazard ratio (HR), with a 95% confidence interval (CI) as the measure of the association of each category with alcohol intake. A total of 11 studies including 46,916 individuals with BMD assessment and 8 studies including 240,871 individuals with risk of fracture analysis were included. Compared to non-drinkers, consumption of up to two standard drinks of alcohol per day was correlated with higher lumbar and femur neck BMD values, while up to one standard drink of alcohol was correlated with higher hip BMD compared to no alcohol consumption. Higher risk of hip fractures was found starting from three standard drinks of alcohol per day (RR = 1.33, 95% CI: 1.04; 1.69 for three alcoholic drinks/d, and RR = 1.59, 95% CI: 1.23; 2.05 for four alcoholic drinks/d) compared to no alcohol consumption, with no evidence of heterogeneity. Concerning the risk of any osteoporotic fractures, the risk steadily increased with higher intake of alcohol, although never reaching statistical significance. In conclusion, there is consistent evidence that increased alcohol consumption is associated with higher risk of osteoporotic hip fracture; however, the role of alcohol at lower doses is uncertain, as BMD was even higher in light drinkers compared to abstainers.
Highlights
The extension of lifespan and the increasing aging population are changing the global burden of diseases, with age-related conditions becoming increasingly prevalent among the older population [1]
There was a potential effect modification by sex, as the findings reported for lumbar bone mineral density (BMD) were significant in all categories of exposure when considering datasets from men, but not from women; the differences in femur neck and hip BMD between one standard drink and no alcohol consumption were significant when stratified by sex (Table S3)
Higher risk of hip fractures was found starting from three standard drinks of alcohol per day (RR = 1.33, 95% confidence interval (CI): 1.04; 1.69 for three alcoholic drinks/d, and relative risk (RR) = 1.59, 95% CI: 1.23; 2.05 for four alcoholic drinks/d) compared to no alcohol consumption, with no evidence of heterogeneity
Summary
The extension of lifespan and the increasing aging population are changing the global burden of diseases, with age-related conditions becoming increasingly prevalent among the older population [1]. Bone health is one of the major interests in aging research, and is an important target to reduce the risk of fractures and increase quality of life in older individuals [2]. Osteoporosis represents an important cause of fracture in this population, affecting more than 200 million people worldwide, and resulting in more than 5 million disability-adjusted life years (DALYs) globally per year [3]. Osteoporosis is a condition characterized by loss of bone mass and deterioration of bone microarchitecture [4]. The occurrence of osteoporosis increases the risk of bone fracture, substantially decreasing the quality of life of older individuals [6]. It is imperative to investigate potential risk factors for osteoporosis in order to prevent fractures
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