The Connection Between Alcohol Misuse and Bone Health

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What you eat and drink influences your health. But what about alcohol and bone health? Can drinking alcohol affect the way your bones grow, heal, and age?

How Are Alcohol and Bone Health Connected?

Bone is a tissue that lives and grows in the body. It consists of calcium that hardens and provides protection for major organs, including the brain and lungs. Although the bones are hard, they are also flexible, allowing the body to move in multiple directions.

Bone growth is rapid until young adulthood. But after age 20, bone loss occurs more quickly than bone growth.¹

The more bone density a person loses, the more likely they can develop diseases like osteoporosis. However, lifestyle factors can slow and possibly prevent bone loss, including eating a diet that provides calcium and vitamin D.¹

Calcium

Calcium is a mineral in the bones that muscles, bones, nerves, and cells need to function correctly. However, the body cannot make calcium. Instead, calcium comes from foods, drinks, or supplements. A lack of calcium makes bones fragile.²

Heavy alcohol consumption depletes calcium by affecting intestinal absorption.

Vitamin D

Low vitamin D levels can contribute to calcium deficiencies, also called osteomalacia. Many people diagnosed with alcohol use disorder exhibit low vitamin D levels. Interestingly, when someone stops misusing alcohol, it only takes days for the body to begin replenishing bone loss.

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Studies show that women with low vitamin D levels and alcohol use disorder may experience an increase in bone formation within the first five days of abstinence. It can take up to two weeks for men.³

Other Alcohol-Related Risk Factors

Other risk factors include:²

• Malnutrition—Heavy alcohol misuse can cause malnutrition and also cause loss of bone mass density.
• Reduced cellular activity—At the cellular level, alcohol affects osteoblast activity, or the activity of the cells that grow bone.
• Estrogen reduction—Estrogen prevents bone loss, except when large amounts of alcohol are present, which will inhibit estrogen.

Does Drinking Alcohol Cause Bone Loss?

Prolonged alcohol misuse can lead to bone loss, weakness, deterioration, and slow healing. It can also lead to bone diseases that can lead to abnormalities in the skeletal system. Any bone in the body can develop the disease, some reversible, and some are not.

Alcohol-Related Osteoporosis

Bones in the human body are constantly changing and reforming. The body discards old bone and replaces it with new bone material. With osteoporosis, replacing the old bone doesn’t happen fast enough, causing weak spots.⁴

Chronic alcohol misuse that begins in adolescence can lead to numerous effects on the body. It can harm the liver, the brain, the endocrine system, and bone density.

In a study of males with heavy alcohol consumption, rates of osteoporosis were higher. Researchers believe that alcohol misuse is the second leading cause of osteoporosis among men. ⁵

Furthermore, heavy alcohol use leads to specific health problems that alone and together increase the risk of osteoporosis, including liver dysfunction and hyperparathyroidism.⁵

Additional osteoporosis risk factors with indirect effects of heavy alcohol misuse include the following:⁶

• Decreases in estrogen in women and testosterone in men
• Increases in inflammation in the body
• Increases in falls or accidents

Alcohol-Related Osteoarthritis

Osteoarthritis occurs when the protective and flexible tissue at the ends of bones wears down, causing joint pain. Environmental and lifestyle factors that create oxidative stress and inflammation are risk factors for developing osteoarthritis. Chronic alcohol misuse causes reactive oxygen species that cause stress in tissues and cells. Excessive alcohol consumption also causes inflammation in all the major organs.⁷

One study comparing beer and wine consumption as a possible link to osteoarthritis in the joints shows that beer may increase the risk of osteoarthritis in the knees and hips. However, the study indicated the possibility that wine may decrease this risk.⁸

A key determinant in the relationship between alcohol and bone health seems to be the amount consumed. Moderate alcohol use is less of a risk factor and may even be a protective factor in bone health based on preliminary research. Heavy or excessive alcohol consumption has both short– and long-term consequences for bone density and deterioration.⁹

Alcohol-Related Osteonecrosis

Osteonecrosis is a bone disease that refers to the death of bone cells that can lead to disability if left untreated. As the disease progresses, joints may collapse. Osteonecrosis typically occurs in long bones, such as femurs.

The pain associated with this disease happens gradually. Excessive alcohol misuse is a risk factor for osteonecrosis development, and studies show it contributes to the majority of cases—over two thirds.¹⁰

Alcohol is said to be responsible for the onset of approximately 31% of persons with osteonecrosis.

Alcohol is also a primary contributor to a rarer form of this disease called multifocal osteonecrosis. “Multifocal” means more than one joint is involved. Usually, it starts in the hip joint, and then the knee joints are affected.¹¹

There are reportedly between 20,000 and 30,000 new cases of osteonecrosis diagnosed each year. It is more common in men and usually appears between 30 and 65. ¹²

Does Drinking Alcohol Slow Bone Healing?

An estimated 10-18% of emergency room visits each year are alcohol related—about 210,000 ER visits annually.¹³

While there is not current research into how many of these visits are for bone fractures, over two million bone fractures occur each year in the U.S., with overlap due to the increased risk of falls and other accidents while intoxicated.

Those who survive a fall with a fracture of any severity level must alter their life until healing is complete. If given pharmacological medicines to cope with the pain of a fracture, mixing alcohol with prescription pain killers can be a fatal combination.¹⁴

What Are the Signs of Alcohol and Bone Health Issues?

Vitamin D deficiencies in someone with an alcohol use disorder are common and can lead to specific symptoms, including:¹⁵

• Bone pain
• Myalgias, or muscle aches and pains
• Arthralgias, or joint stiffness
• Weakness
• Muscle twitching
• Falls
• Fractures

Signs of bone diseases like alcohol-related osteoporosis may progress over a long period. As they progress, they become more noticeable physically. Symptoms include:¹⁶

• Back pain
• Back is hunched
• Shoulders tend to lean forward
• Height appears to get shorter
• Limited range of motion

Someone misuse alcohol to cope with the symptoms of poor bone health while unintentionally making them worse. Even when they recognize alcohol is not easing their pain, if they cannot stop using it this is one sign they may be developing an alcohol use disorder.

Other symptoms of alcohol use disorder include:¹⁷

• Spending a lot of time seeking or misusing alcohol
• Experiencing withdrawal symptoms when you try to cut back or quit misusing alcohol
• Continuing to drink even though doing so causes problems personally, professionally, and socially
• Continuing to drink even though you know it is making your medical condition worse

How Can Alcohol and Bone Health Issues Be Addressed?

You can take several positive steps to overcome alcohol and bone health issues, including following the alcohol use guidelines for moderate alcohol consumption. Moderate drinking means consuming one standard drink a day for women and two standard drinks a day for men.

Moderate drinking means having no more than one to two drinks per day. If it is challenging to stop consuming alcohol once you start, or if you feel like alcohol takes control over you once you start drinking, you may have an alcohol use disorder.

Whether your symptoms are mild, moderate, or severe, there are treatment options to help you overcome them. ¹⁸ Seeking treatment and entering recovery may prevent further bone loss and damage and promote bone healing.

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Alcohol recovery treatment centers use integrative care solutions to address physical, psychological, and substance use disorders. Components of a treatment plan are individualized and created to reduce alcohol misuse and improve bone health. A sample plan may include:

• Medication to ease withdrawal symptoms, strengthen bones, and treat co-occurring disorders if any exist
• Behavioral therapies to learn new coping mechanisms to reduce alcohol consumption and enhance bone health
• Education about alcohol and bone health
• Support groups to meet peers who may also be affected by alcohol and bone health issues
• Prevention methods to avoid alcohol misuse
• Prevention methods to avoid further bone damage and encourage healthy bone development, including:
  • Bone density testing
  • Exercises to build and maintain bone density and boost positive moods
  • Exercises to improve balance and prevent falls
  • Increased intake of vitamin D, calcium, and other nutrients lost through alcohol misuse and weakened bone health
  • Environmental changes that support personal safety and reduce alcohol consumption
• Family therapy to help loved ones learn how to support you in this journey

Many treatment programs with licensed professionals are ready to help you overcome alcohol and bone health issues. Call  800-948-8417 Calls are forwarded to these paid advertisers to speak to a specialist that can connect you with alcohol addiction programs.

Resources

1. National Institute of Health Osteoporosis and Related Bone Diseases National Resource Center. (2018). What is Bone?
2. Sheng, B., Li, X., Nussler, A. K., & Zhu, S. (2021). The Relationship Between Healthy Lifestyles and Bone Health: A Narrative Review. Medicine, 100(8), e24684.
3. Gaddini, G. W., Turner, R. T., Grant, K. A., & Iwaniec, U. T. (2016). Alcohol: A Simple Nutrient with Complex Actions on Bone in the Adult Skeleton. Alcoholism, Clinical and Experimental Research, 40(4), 657-671.
4. Oregon State University. (2012, July 11). Moderate Alcohol Consumption May Help Prevent Bone Loss.
5. Song, T. H., Shim, J. C., Jung, D. U., Moon, J. J., Jeon, D. W., Kim, S. J., & Oh, M. K. (2018). Increased Bone Mineral Density after Abstinence in Male Patients with Alcohol Dependence. Clinical Psychopharmacology and Neuroscience, 16(3), 282-289.
6. Pouresmaeili, F., Kamalidehghan, B., Kamarehei, M., & Goh, Y. M. (2018). A Comprehensive Overview on Osteoporosis and Its Risk Factors. Therapeutics and Clinical Risk Management, 14, 2029-2049.
7. Kc, R., Voigt, R., Li, X., Forsyth, C. B., Ellman, M. B., Summa, K. C., Turek, F. W., Keshavarzian, A., Kim, J. S., & Im, H. J. (2015). Induction of Osteoarthritis-like Pathologic Changes by Chronic Alcohol Consumption in an Experimental Mouse Model. Arthritis & Rheumatology, 67(6), 1678-1680.
8. Muthuri, S. G., Zhang, W., Maciewicz, R. A., Muir, K., & Doherty, M. (2015, February 05). Beer and Wine Consumption and Risk of Knee or Hip Osteoarthritis: A Case-Control Study. Arthritis Research & Therapy, 17(1), 23.
9. Turk, J. N., Zahavi, E. R., Gorman, A. E., Murray, K., Turk, M. A., & Veale, D. J. (2021). Exploring the Effect of Alcohol on Disease Activity and Outcomes in Rheumatoid Arthritis Through Systematic Review and Meta-Analysis. Scientific Reports, 11(1), 10474.
10. Seamon, J., Keller, T., Saleh, J., & Cui, Q. (2012). The Pathogenesis of Nontraumatic Osteonecrosis. Arthritis, 601763.
11. Matsumoto, K., Ogawa, H., & Akiyama, H. (2015). Multifocal Osteonecrosis Secondary to Chronic Alcohol Ingestion. Case Reports in Orthopedics, 2015, 137273.
12. Lespasio, M. J., Sodhi, N., & Mont, M. A. (2019). Osteonecrosis of the Hip: A Primer. The Permanente Journal, 23, 18-100.
13. National Institute on Alcohol Abuse and Alcoholism. (2021). Alcohol Facts and Statistics.
14. Chikritzhs, T., & Livingston, M. (2021). Alcohol and the Risk of Injury. Nutrients, 13(8), 2777.
15. Sizar O, Khare S, Goyal A, et al. (2021). Vitamin D Deficiency.
16. National Institute of Health Osteoporosis and Related Bone Diseases National Resource Center. (2021). Osteoporosis Overview.
17. National Institute of Alcohol Abuse and Alcoholism. (2021). Understanding Alcohol Use Disorder.
18. Alcohol Research: Current Reviews. (2018, January 01). Drinking Patterns and Their Definitions.