Bone Health Research Articles (Page 1)

Bone mineral density (BMD) is a key indicator of bone health, particularly in older populations, where lower BMD is linked to increased risk of osteoporosis and fractures. Metabolic factors like serum uric acid (UA) and high-density lipoprotein cholesterol (HDL-C) have emerged as possible determinants of bone health. The uric acid to HDL cholesterol ratio (UHR) may offer a new perspective on these metabolic influences. This study explores the association between UHR and femoral neck BMD, with a focus on non-linear relationships and subgroup variations by body mass index (BMI), age, and sex. The study used data from 2178 participants from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). UHR was calculated as the ratio of serum UA to HDL-C. BMD measurements were obtained using dual-energy X-ray absorptiometry (DXA) at the femoral neck. A two-piecewise linear regression model was applied to examine the non-linear relationship between UHR and BMD. Stratified analyses were conducted by BMI, gender, and age groups. A significant inflection point was found at UHR 19. Below this threshold, UHR was positively associated with femoral neck BMD (β = 0.0054, p = 0.013), while above the threshold, the association was negative but not statistically significant (β = -0.0016, p = 0.478). Stratified analysis revealed that the relationship between UHR and BMD remained significant among Mexican Americans even after adjusting for covariates (β = 0.0145, p = 0.012). This study identifies a non-linear association between UHR and femoral neck BMD, with a key inflection point at UHR 19. These findings suggest that UHR could be a useful biomarker for bone health, especially in populations with higher metabolic risks. Further longitudinal studies are necessary to establish causality and explore potential interventions targeting UHR to improve bone health.

Emerging evidence suggests that lipid metabolism plays a critical role in bone homeostasis. The ratio of remnant cholesterol/high-density lipoprotein cholesterol (RC/HDL-C) has recently been proposed as a novel indicator of metabolic risk; however, its relationship with bone mineral density (BMD) remains unclear. This study aimed to explore the association between RC/HDL-C and total BMD in a nationally representative population. Data were derived from the 2011-2018 National Health and Nutrition Examination Survey, including 3688 US adults aged 20 to 59 years. The RC/HDL-C ratio was calculated as (total cholesterol - HDL-C - low-density lipoprotein cholesterol)/HDL-C. Total BMD was measured using dual-energy x-ray absorptiometry. Multivariable linear regression models were used to examine the association between RC/HDL-C and BMD, adjusting for demographic, lifestyle, and clinical covariates. Nonlinear associations were explored via smooth curve fitting and threshold effect analyses. Subgroup and interaction analyses were also conducted. A significant inverse association was observed between RC/HDL-C and total BMD. After full adjustment, each 1-unit increase in RC/HDL-C was associated with a 0.019 g/cm² decrease in BMD (β = -0.019; 95% confidence intervals (CI): -0.027 to -0.010; P < .0001). Quartile analysis revealed a dose-response relationship, with the highest quartile showing the strongest negative association (β = -0.029; 95% CI: -0.039 to -0.020; P < .0001). A nonlinear relationship was identified, with an inflection point at 0.677; below this value, the negative association was more pronounced (β = -0.049; 95% CI: -0.068 to -0.030; P < .0001). Subgroup analyses confirmed consistent associations across most groups, and a significant interaction was found with smoking status (P for interaction .05). RC/HDL-C was inversely associated with BMD, with stronger associations observed in smoking status. These findings highlight the RC/HDL-C ratio as a potential predictor for bone health risk stratification and warrant further investigation in longitudinal and mechanistic studies.

Osteoporosis is a prevalent skeletal disorder characterized by reduced bone mass and increased fracture risk. This study employed a 2-sample Mendelian randomization analysis to investigate the causal relationships between circulating micronutrient levels and bone health indicators, including heel broadband ultrasound attenuation, quantitative ultrasound index, bone mineral density, and osteoporosis risk. Genetic instruments were derived from large-scale genome-wide association studies. Among all tested micronutrients, zinc uniquely demonstrated causal associations with heel bone parameters. Specifically, genetically predicted higher zinc levels were negatively associated with heel broadband ultrasound attenuation (odds ratio [OR] = 0.972, P = .001), quantitative ultrasound index (OR = 0.981, P = .002), and bone mineral density (OR = 0.969, P < .001). However, no significant causal effect was observed on overall osteoporosis risk (OR = 0.999, P = .217). Sensitivity analyses confirmed the robustness of these findings, with no evidence of horizontal pleiotropy. These results help clarify the complex relationship between zinc and bone quality and fill a critical knowledge gap by demonstrating that while zinc correlates with specific bone parameters, it may not directly reduce osteoporosis risk. Further randomized controlled trials are needed to validate these findings and explore their clinical implications.

Effects of Swimming and Running Exercise-Induced Changes in Muscle Fibers, Bone Structure, and Oxidative Stress in Aging Rats.

People with Down syndrome represent a highly vulnerable population, frequently showing vitamin D deficiency together with an elevated risk of metabolic and neuromuscular dysfunction. This susceptibility derives from several factors, including muscular hypotonia, excess body weight, thyroid abnormalities, and immune dysregulation. The coexistence of these conditions compromises bone and muscle health, increases cardiometabolic risk, and reduces motor abilities and coordination, thereby predisposing individuals to falls, sarcopenia, sarcopenic obesity, and long-term disability. Vitamin D, traditionally known for its essential role in bone health, is now recognized as a pleiotropic hormone regulating immune responses, metabolic balance, and muscle performance. Its deficiency is increasingly linked to obesity, insulin resistance, diabetes mellitus, dyslipidemia, and metabolic syndrome. These adverse outcomes are mediated through mechanisms involving chronic inflammation, oxidative stress, mitochondrial impairment, and disrupted adipokine signaling. This review integrates current molecular, cellular, and clinical evidence on the multifaceted actions of vitamin D in Down syndrome. Particular emphasis is placed on its effects on insulin signaling, adipose tissue metabolism, inflammatory regulation, and muscle strength. Finally, vitamin D is discussed as a biomarker and therapeutic target to guide personalized interventions aimed at improving metabolic health, maintaining muscle function, and promoting long-term independence in this high-risk population.

For many years, menopause-related bone loss has been attributed solely to declining estrogen levels. Recently it has been suggested that bone loss accelerates during perimenopause, often preceding declines in estradiol (E2), proposing that follicle-stimulating hormone (FSH), the levels of which are high during late perimenopause, may play a role in skeletal deterioration independently of E2. The aim of this narrative review was to present aspects of bone health throughout the menopause transition with a focus on the relationship between FSH and bone-related outcomes. Epidemiological studies evaluating bone mineral density (BMD) and bone turnover markers (BTMs) were analyzed. Higher FSH levels were associated with reduced BMD, particularly at the spine and hip, as well as enhanced bone remodeling activity. In several longitudinal studies, FSH was found to be a more reliable predictor of bone loss than estrogen. In conclusion, FSH may serve as an early marker of perimenopausal bone health deterioration by identifying women at risk for bone loss and allowing for more personalized prevention strategies; however, further research is needed before its clinical use.

This study evaluated the effects of limestone particle size and 25-hydroxycholecalciferol supplementation on performance, egg quality, digestive organ biometrics, bone characteristics, thermoregulatory responses, and behavior of brown laying hens reared under hot environmental conditions. The trial lasted five periods of 28 days. A total of 270 Lohmann Brown Lite hens (48 weeks old) were allocated in a completely randomized design with a 2 × 2 + 1 factorial arrangement, comprising two limestone particle sizes (MGD 0.568 mm and MGD 1.943 mm) and two supplementation levels of vitamin D (2760 IU and 1380 IU), plus a control diet, totaling five treatments with six replicates each. The dietary treatments were as follows: (1) control diet without vitamin D supplementation; (2) 250 g vitamin D with 100% fine limestone; (3) 125 g vitamin D with 100% fine limestone; (4) 250 g vitamin D with 50% fine + 50% coarse limestone; and (5) 125 g vitamin D with 50% fine + 50% coarse limestone. Productive performance, egg quality, organ biometrics, bone traits, thermoregulatory variables, and behavioral indicators were measured. Data were analyzed by ANOVA, followed by Tukey test (5%), considering the factorial model. There was no interaction between the factors for any parameter evaluated. There was an effect of shift on thermoregulatory variables. The other variables were not influenced by the treatments. These findings indicate that the tested limestone particle sizes can be incorporated in the diets of brown laying hens without affecting performance, egg quality, bone integrity, thermoregulation, or behavior, regardless of vitamin D supplementation, under hot climatic conditions.

Public health problems regarding the potential association between Parkinson's disease (PD) and the increased prevalence of osteoporosis have been raised. However, the exact relationship, as well as potential treatment strategies, remains unclear and requires further investigation. Melatonin (MLT) is known for its beneficial effects on bone metabolism and its strong neuroprotective properties. Therefore, this study aimed to evaluate the potential role of MLT in the prevention and treatment of bone loss associated with PD using an hemiparkinsonian rat model induced by the destruction of dopaminergic neurons following intracerebral injection of 6-hydroxydopamine (6-OHDA). Forty male Wistar rats were divided into 5 groups: Control (CTR), 6-OHDA, MLT, 6-OHDA + MLT 1, and 6-OHDA + MLT 15. MLT (20 mg/kg/day) was administered intraperitoneally from Day 1 or Day 15, depending on the group. The effects on locomotor performance, oxidative status, bone structure, collagen accumulation, mineralization and the expression of bone marker proteins and genes were examined. Our results showed that the degeneration of dopaminergic neurons caused by 6-OHDA significantly impaired locomotor performance and induced marked alterations in bone parameters. Early MLT treatment (Day 1) mitigated these bone alterations by preserving structural integrity, enhancing collagen accumulation, and modulating bone marker expression. Importantly, beneficial effects on bone were also observed when MLT was administered later (Day 15), despite the absence of significant improvement in motor deficits. These findings suggest that dopaminergic neuron degeneration can negatively influence bone health and that MLT may exert a direct osteoprotective effect, supporting its possible therapeutic utility in managing bone fragility associated with PD.

Background: Cardiovascular-Kidney-Metabolic (CKM) syndrome is a newly defined framework describing the interconnected pathophysiology of obesity, metabolic dysfunction, kidney disease, and cardiovascular complications. CKM may negatively impact bone health through chronic inflammation, insulin resistance, and adipokine dysregulation. Low bone mineral density (BMD) is a key risk factor for fractures, which raise healthcare costs due to complications like impaired mobility, venous thromboembolism, and hospital-acquired infections. Despite CKM’s high prevalence, its relationship with bone health remains unclear. Understanding this link could improve fracture risk assessment and early intervention. Methods: We conducted a cross-sectional analysis of 9,186 adults aged ≥40 years from the National Health and Nutrition Examination Survey (NHANES) 2005–2018. Participants were classified into CKM stages (0–4) per American Heart Association criteria. BMD at the femoral neck, lumbar spine, and total hip was measured using dual-energy X-ray absorptiometry. Multivariable logistic regression evaluated associations between CKM stages and BMD categories (normal, osteopenia, osteoporosis), adjusting for demographic, socioeconomic, lifestyle, laboratory, and medication factors. Results: Among U.S. adults ≥40, 93.9% had CKM, with 26.8% in advanced stages (3–4). A non-linear relationship between CKM stage and BMD was observed. Stage 1 (overweight/obesity or prediabetes) had the highest prevalence of normal BMD (64%) and lowest osteoporosis prevalence (5%). Advanced stages showed increased osteopenia (46.8%, 44.7%) and osteoporosis (13.9%, 12.0%). Stage 0 (normal weight, metabolically healthy) also had high osteopenia (49.5%) and osteoporosis (10.8%). Femoral neck BMD was most affected, while hip BMD was relatively preserved. However, associations with bone loss were attenuated after adjusting for age. Full prevalence estimates with 95% confidence intervals are presented in Figure 1. Conclusions: CKM syndrome is linked to lower BMD, especially at the femoral neck, with higher rates of osteopenia and osteoporosis in advanced stages. FRAX screening in advanced CKM could guide DXA use and treatment decisions (e.g., bisphosphonates). Strength training should be promoted among adults ≥50 to help preserve BMD and reduce fracture risk.

Background. Osteoporosis is an age-related metabolic disease that has a significant impact on bone health and overall quality of life. It is gaining importance as one of major medical concerns with the rapid increase in the geriatric population in our world. The aim of the study was to determine the biochemical markers of bone and cartilage tissue metabolism in urine of patients with newly sustained compression fractures of vertebrae in adjacent and distant segments. Subjects and methods. The research was conducted at the M. I. Sytenko Institute of Spine and Joint Pathology, National Academy Medical Science of Ukraine for 2023–2025. The diagnosis of osteoporosis was confirmed using densitometry. The age of patients in group I ranged from 55 to 72 years, in the group II – from 55 to 73 years, and in the group III – from 56 to 72 years. The T-scores were as follows: Group I, −0.8±0.2; Group II, −2.63±0.3; and Group III, −2.8±0.26. Statistical analysis of the data was carried out using the software packages Microsoft Excel XP and Statsoft Statistica 6.0. Results and conclusion. In patients from Group II, who had concomitant osteoporosis compared to Group I, new vertebral compression fractures occurred following spinal surgery against the background of osteoporosis. These changes were reflected in alterations in biochemical markers of bone and cartilage tissue, including: increased levels of glycoproteins in the blood (markers of systemic inflammation), elevated chondroitin sulfates (indicating bone and cartilage degradation), increased activity of alkaline phosphatase (specifically its bone isoenzyme) and acid phosphatase (markers of bone metabolism), higher levels of ionized calcium (indicative of mineral matrix destruction), as well as enhanced urinary excretion of hydroxyproline (a marker of collagen catabolism) and uronic acids (metabolites of proteoglycans from bone and cartilage tissue). The laboratory studies conducted indicate the possibility of using a complex of biochemical markers in assessing the risks of progression of destruction of bone and cartilage tissue after fractures in patients, which may lead to the need for repeated surgical interventions.

Background: Osteoporosis and sarcopenia are common but underrecognized contributors to frailty in older adults undergoing transcatheter aortic valve replacement (TAVR). Standard risk scores omit musculoskeletal parameters despite their known association with adverse outcomes. Objective: To evaluate whether osteoporosis predicted by an AI-based model using routine pre-TAVR CT scans is associated with long-term mortality in a large, multicenter TAVR cohort. Methods: We developed a radiomics-based machine learning model trained on 252 patients with paired CT and dual-energy X-ray absorptiometry (DXA) scans from Jewish General Hospital and McGill University Health Centre (Canada). The model estimated lumbar bone mineral density (BMD) and T-scores and was applied to preprocedural contrast-enhanced CT scans routinely acquired for TAVR planning in 906 patients across five institutions in the US, Canada, and Ireland. Osteoporosis was defined as AI-predicted T-score ≤ –2.5. Skeletal muscle density was extracted from the same CTs. Associations with all-cause mortality were assessed using Cox regression. Results: The radiomics-based regression model demonstrated strong agreement with DXA-derived BMD, achieving a mean absolute error of 0.06, R 2 of 0.87, and correlation coefficient of 0.93. The corresponding classification model predicting WHO T-score categories (normal, osteopenia, osteoporosis) achieved an overall accuracy of 0.82. Applied to the external TAVR cohort (n=906), the model identified 3.0% (27/906) of patients as osteoporotic (T-score ≤ –2.5). AI-defined osteoporosis was significantly associated with increased long-term mortality (HR 2.27; 95% CI: 1.23–4.19; p=0.009). Higher skeletal muscle density was also associated with reduced mortality (HR per 1 HU increase: 0.987; p=0.041). Patients classified as osteoporotic had lower muscle volume and higher frailty scores. Kaplan–Meier survival analysis further demonstrated that osteoporotic patients had significantly lower long-term survival. Although only 3% of the cohort had osteoporosis, survival curves diverged early and remained separated, suggesting this subgroup represents a clinically vulnerable population. Conclusion: An automated AI-based model accurately estimates BMD from routine pre-TAVR imaging and identifies patients at increased mortality risk. Opportunistic CT-based assessment of bone and muscle health may enhance frailty screening and risk stratification in older adults undergoing TAVR.

Erythemal ultraviolet (EUV) irradiance, with a wavelength range of 280–400 nm, is associated with both health risks and physiological benefits. While moderate EUV exposure stimulates vitamin D synthesis—essential for bone health and immune function—excessive exposure can cause skin damage, ocular complications, and increased risk of skin cancer, highlighting the need for accurate UV monitoring. However, ground-based measurements remain limited due to the high cost of instrumentation. This study introduces a semi-empirical model for estimating hourly EUV irradiance in Thailand using meteorological and satellite data. The model was developed using cloud index, visibility, total column ozone, and the cosine of the solar zenith angle across four stations: Chiang Mai, Ubon Ratchathani, Nakhon Pathom, and Songkhla. The baseline model, constructed using data from 2016 to 2019, achieved a mean bias difference (MBD) of 3.57%, a root mean square difference (RMSD) of 21.80%, and an R² of 0.81. However, its performance declined in areas with high aerosol loading and low visibility, particularly in Chiang Mai, where seasonal biomass burning is prevalent. To improve accuracy, a modified model was developed by incorporating aerosol optical depth (AOD) at stations where such data were available. The enhanced model yielded an MBD of 6.18%, an RMSD of 15.16%, and an R² of 0.93. These results highlight the critical role of aerosols in UV attenuation and demonstrate the model’s potential for scalable, cost-effective applications in UV risk assessment, especially in regions lacking high-resolution ground monitoring infrastructure.

To develop consensus-based guidance for bone health optimization in instrumented spine surgery, specifically addressing the limited guidance available in the Thai context. The study utilized a modified Delphi technique, engaging 10 orthopedic surgeons from Thailand with expertise in complex spine surgery and osteoporosis management. A targeted literature review was conducted, followed by 2 online surveys and a face-to-face consensus meeting to develop and refine the statements. Twenty-five main statements and 45 substatements that focused on patient evaluation, assessment tools, and risk stratification were drafted for the panel's deliberation. There was unanimous agreement on the necessity of evaluating bone health before instrumented spine surgery in patients aged ≥60 years, while evaluation was considered optional for those aged 50 to 59 years. The panelists supported using the fracture risk assessment tool score for clinical evaluation and recommended using several assessment tools, including dual-energy x-ray absorptiometry scans for specific age groups, Computed Tomography Hounsfield Unit, Trabecular Bone Score, and vertebral fracture assessment for bone health evaluation if available. Treatment recommendations included bone-forming agents as the first-line therapy for patients at high risk and very high risk and specialized surgical techniques for patients at very high risk. Surgical delay of at least 3 months should also be considered for patients at very high risk/with severe osteoporosis who have been scheduled for instrumented spine surgery. This guidance includes patient screening, evaluation, and treatment for patients with poor bone health based on risk stratification, including normal/low risk, osteopenia/intermediate risk, osteoporosis/high risk, and severe osteoporosis/very high risk. Spine surgeons should be aware of poor bone health and consider bone health optimization to improve surgical outcomes and prevent osteoporosis-related complications. Bone health optimization is crucial for instrumented spine surgery. Spine surgeons should consider bone health optimization guidance, including patient screening for poor bone health, assessment tools for evaluating bone health, and treatment for patients with poor bone health, to improve surgical results and minimize poor bone health-related complications.

Frailty is an ageing-related syndrome of physiological decline, heightening vulnerability and increasing the risk of adverse health outcomes. Nutritional deficiencies, particularly in vitamins B9, B12, and D, are prevalent among the elderly due to physiological changes and reduced food intake. Research suggests a correlation between low levels of these vitamins and an elevated risk of frailty. Vitamin B9, crucial for DNA synthesis and cell division, shows potential in frailty prevention, although evidence regarding supplementation remains inconclusive. Similarly, vitamin B12, essential for nerve function and red blood cell formation, presents conflicting findings regarding its impact on frailty prevention. Vitamin D, essential for bone health and muscle function, is linked to frailty risk, yet studies on the efficacy of supplementation yield mixed results. The mechanisms involving these vitamins, including their roles in DNA methylation and inflammation regulation, highlight the need for further research to clarify their direct impact on frailty prevention. Maintaining optimal levels of vitamins B9, B12, and D may reduce frailty, but older individuals need a complete approach that includes proper nutrition, physical activity, and other preventive measures.

Background: Vitamin D plays a crucial role in maintaining muscle and bone health and has been increasingly implicated in neurological disorders, including depression and anxiety, which are closely associated with dysregulation of the serotonin 1A receptor (5-HT1A receptor). This study employs molecular modeling techniques to investigate the potential agonistic activity of Vitamin D on the 5-HT1A receptor. Additionally, it seeks to elucidate the key structural motifs and molecular interactions that underline the binding affinity between Vitamin D and the receptor. The insights gained from this research may inform the design of Vitamin D-derived compounds with optimized pharmacological profiles, contributing to therapeutic advancements in related neurological condi-tions. Methods: We selected five structures of the 5-HT1A receptor (PDB IDs: 7E2Y, 7E2Z, 8W8B, 8JSP, and 8JT6) for Protein-Ligand Interaction Fingerprint (PLIF) analysis. We conducted molecular dock-ing to evaluate the binding efficiency of two forms of Vitamin D,ergocalciferol and cholecalciferol, to the 5-HT1A receptor. Following this, we performed Molecular Dynamics (MD) simulations to assess the stability of these interactions. Results: Docking results revealed binding energies below -6.64 kcal/mol for both forms of Vitamin D, with ergocalciferol achieving a maximum binding energy of -7.78 kcal/mol. ASP116 emerged as a pivotal residue in stabilizing these interactions. MD simulations indicated that the Vitamin D-5-HT1A complexes exhibited stability comparable to the serotonin-bound 5-HT1A receptor complex. Conclusion: Our study suggests that Vitamin D may function as an agonist for the 5-HT1A receptor, with ASP116 playing a critical role in binding. Yet, further in vitro and in vivo studies are necessary to validate these findings and explore the therapeutic potential of Vitamin D-derived compounds.

13415 Effect of Medical Therapies for Endometriosis on Bone Health: A Systematic Review and Meta-Analysis

The effect of flavan-3-ols on ovariectomy-induced bone loss in mice and the potential mechanisms.

Branched-chain amino acids in bone health: From molecular mechanisms to therapeutic potential.

Bone is a complex structure formed by cancellous and cortical bone compartments. Whereas cancellous bone remodeling has been studied extensively, less is known about mechanisms that lead to cortical bone formation and homeostasis. Corticalization is a poorly understood process, when newly formed trabeculae coalesce to consolidate as cortical bone in early life, but with an impact on skeletal integrity that is sustained throughout life. Failure to form cortical bone results in pronounced skeletal fragility, although the process is poorly understood. Mouse models of Sp7, Itgb3, Socs3 and Clcn7 inactivation exhibit impaired corticalization and cancellous bone osteopetrosis. The relationship between the two events has not been established. Notch receptors (1 through 4) are critical determinants of cell differentiation and function in the skeleton. NOTCH3 is structurally distinct and has a well-defined pattern of cellular expression, in smooth muscle vascular cells and osteocytes, conferring this Notch receptor a unique role in physiology. Mouse models expressing the biological active NOTCH3 intracellular domain (N3ICD) in Bglap+ osteoblasts and Dmp1+ osteocytes do not form cortical bone and display skeletal fragility, increased intracortical remodeling and cortical porosity, reflecting a bone structure that failed to mature. The mechanism may involve suppression of Sp7 and induction of granzyme B. In conclusion, corticalization is a poorly understood process that is essential to maintain skeletal integrity and with lifelong impact on bone health.

Diabetes and excessive alcohol consumption both negatively impact bone health independently. However, their combined effect is unclear. Therefore, this study aimed to investigate humerus trabecular morphometry and tensile strength in diabetic rats that consumed alcohol. Thirty- one (31) 10-week-old male Sprague-Dawley rats weighing 330g-370g were used. Rats were grouped as follows: untreated (control), which got no treatment (n=8); ALC, which consumed alcohol (n=8); and DB, diabetic group (n=7). The study also included an additional diabetic group that received alcohol, (DB+ALC) (n=8). Serum insulin and fasting blood glucose levels were used to confirm diabetes, which was induced by a high-fructose diet and streptozotocin. ALC rats received drinking water with 10% v/v alcohol daily until termination at 24 weeks of age. Afterwards, bilateral humeri were dissected and stored in 10% buffered formalin before osteometric measurements were recorded. Micro-focus X-ray computed tomography (Micro CT) scanning was then conducted to evaluate trabecular number (TbN), thickness (TbTh), spacing (TbSp), bone tissue volume ratio (BV/TV) before undergoing, and tensile strength tests. The DB+ALC group had shorter humeri, although the bicondylar breadth was similar among all groups. The DB+ALC and the DB group showed diminished trabecular thickness (TbTh), but more trabeculae (TbN). The maximum and break force were the lowest in the DB+ALC group. Diabetic skeletopathy worsens with alcohol use, leading to shorter bones with lower trabecular thickness, maximum, and break force in the DB+ALC treated group. We suggest increased bone health monitoring for diabetic patients who consume alcohol.