Alcohol intake as a risk factor for fracture

Kanis, John A.<sup>1</sup>; Johansson, Helena<sup>2</sup>; Johnell, Olof<sup>3</sup>; Oden, Anders<sup>2</sup>; De Laet, Chris<sup>4</sup>; Eisman, John A.<sup>5</sup>; Pols, Huibert<sup>6</sup>; Tenenhouse, Alan<sup>7</sup>

Affiliations

¹WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK

²Consulting Statistician, Gothenburg, Sweden

³Department of Orthopaedics, Malmo General Hospital, S-214 01 Malmo, Sweden

⁴Department of Public Health, Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands

⁵Bone and Mineral Research Program, Garvan Institute of Medical Research, St Vincent’s Hospital and University of NSW, Sydney, Australia

⁶Department of Internal Medicine, Erasmus University, Rotterdam, The Netherlands

⁷Division of Bone Metabolism, The Montreal General Hospital, Montreal, Canada

Abstract and keywords

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.

Keywords: Alcohol; Hip fracture; Meta-analysis; Osteoporotic fracture; Risk factors

Links

DOI: 10.1007/s00198-004-1734-y

PubMed: 15455194

WoS: 000230175800004

History

Received: 2004-03-18

Accepted: 2004-08-03

Online: 2004-09-29

Cited Works (8)

Year	Entry
2000	Delmas PD, Eastell R, Garnero P, Seibel MJ, Stepan J; Committee of Scientific Advisors of the International Osteoporosis Foundation. The use of biochemical markers of bone turnover in osteoporosis. Osteoporos Int. December 2000;11(suppl 6):S2-S17.
1997	Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D; European Foundation for Osteoporosis and Bone Disease. Guidelines for diagnosis and management of osteoporosis. Osteoporos Int. July 1997;7(4):390-406.
2002	Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. June 1, 2002;359(9321):1929-1936.
1994	Jones G, Nguyen T, Sambrook PN, Kelly PJ, Gilbert C, Eisman JA. Symptomatic fracture incidence in elderly men and women: the Dubbo Osteoporosis Epidemiology Study (DOES). Osteoporos Int. September 1994;4(5):277-282.
1995	Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM; Study of Osteoporotic Fractures Research Group. Risk factors for hip fracture in white women. NEJM. March 23, 1995;332(12):767-773.
2000	Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA III, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. April 2000;15(4):721-739.
1991	Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O'Brien LA, Hoffman S, Kaplan F; Northeast Hip Fracture Study Group. Risk factors for falls as a cause of hip fracture in women. NEJM. May 9, 1991;324(19):1326-1331.
1999	Kreiger N, Tenenhouse A, Joseph L, Mackenzie T, Poliquin S, Brown JP, Prior JC, Rittmaster RS. The Canadian Multicentre Osteoporosis study (CaMos): background, rationale, methods. Can J Aging. 1999;18(3):376-387.

Cited By (25)

Year	Entry
2017	Compston J, Cooper A, Cooper C, Gittoes N, Gregson C, Harvey N, Hope S, Kanis JA, McCloskey EV, Poole KES, Reid DM, Selby P, Thompson F, Thurston A, Vine N; The National Osteoporosis Guideline Group (NOGG). UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. December 2017;12(1):1-24.
2009	Kanis JA, Oden A, Johansson H, Borgström F, Ström O, McCloskey E. FRAX^® and its applications to clinical practice. Bone. May 2009;44(5):734-743.
2020	Kaur P, Anjana RM, Tandon N, Singh MK, Mohan V, Mithal A. Increased prevalence of self-reported fractures in Asian Indians with diabetes: results from the ICMR-INDIAB population based cross-sectional study. Bone. June 2020;135:115323.
2016	Camacho PM, Petak SM, Binkley N, Clarke BL, Harris ST, Hurley DL, Kleerekoper M, Lewiecki EM, Miller PD, Narula HS, Pessah-Pollack R, Tangpricha V, Wimalawansa SJ, Watts NB. American Association of Clinical Endocrinologists and American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis — 2016. Endocr Pract. September 1, 2016;22(suppl 4):1-42.
2020	Camacho PM, Petak SM, Binkley N, Diab DL, Eldeiry LS, Farooki A, Harris ST, Hurley DL, Kelly J, Lewiecki EM, Pessah-Pollack R, McClung M, Wimalawansa SJ, Watts NB. American Association of Clinical Endocrinologists/American College of Endocrinology Clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis: 2020 update. Endocr Pract. May 2020;26(suppl 1):1-46.
2009	Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P. Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977–2001. J Bone Miner Res. July 2009;24(7):1299-1307.
2010	Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA; Manitoba Bone Density Program. Independent clinical validation of a Canadian FRAX tool: fracture prediction and model calibration. J Bone Miner Res. November 2010;25(11):2350-2358.
2021	Rogmark C, Fedorowski A, Hamrefors V. Physical activity and psychosocial factors associated with risk of future fractures in middle-aged men and women. J Bone Miner Res. May 2021;36(5):852-860.
2007	Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Glüer C, Goltzman D, Hans D, Krieg M-A, La Croix A, McCloskey E, Mellstrom D, Melton LJ, Pols H, Reeve J, Sanders K, Schott A-M, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int. August 2007;18(8):1033-1046.
2008	Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int. April 2008;19(4):385-397.
2008	Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster J-Y, Borgstrom F, Rizzoli R; European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. April 2008;19(4):399-428.
2008	Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A. Case finding for the management of osteoporosis with FRAX^®: assessment and intervention thresholds for the UK. Osteoporos Int. October 2008;19(10):1395-1408.
2011	Kanis JA, Hans D, Cooper C, Baim S, Bilezikian JP, Binkley N, Cauley JA, Compston JE, Dawson-Hughes B, El-Hajj Fuleihan G, Johansson H, Leslie WD, Lewiecki EM, Luckey M, Oden A, Papapoulos SE, Poiana C, Rizzoli R, Wahl DA, McCloskey EV. Interpretation and use of FRAX in clinical practice. Osteoporos Int. September 2011;22(9):2395-2411.
2013	Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster J-Y; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO); Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. January 2013;24(1):23-57.
2019	Kanis JA, Cooper C, Rizzoli R, Reginster J-Y; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO); Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. January 2019;30(1):3-44.
2020	Rasmussen NH, Dal J, de Vries F, van den Bergh JP, Jensen MH, Vestergaard P. Diabetes and fractures: new evidence of atypical femoral fractures? Osteoporos Int. March 2020;31(3):447-455.
2020	Jadzic J, Cvetkovic D, Milovanovic P, Tomanovic N, Zivkovic V, Nikolic S, Djuric M, Djonic D. The micro-structural analysis of lumbar vertebrae in alcoholic liver cirrhosis. Osteoporos Int. November 2020;31(11):2209-2217.
2014	Fonseca H, Moreira-Gonçalves D, Coriolano H-JA, Duarte JA. Bone quality: the determinants of bone strength and fragility. Sports Med. January 2014;44(1):37-53.
2012	Moayyeri A. Risk Assessment for Osteoporotic Fractures Among Men and Women from a Prospective Population Study: The EPIC-Norfolk Study [PhD thesis]. Cambridge, UK: University of Cambridge; 2012.
2016	Oei L. Epidemiological, Radiological and Genetic Aspects of Endocrine Bone Diseases [PhD thesis]. Erasmus University Rotterdam; December 14, 2016.
2020	Axelsson KF. Aspects of Fracture Prevention: The Role of Fracture Liaison Services and Alendronate [PhD thesis]. University of Gothenburg; 2020.
2018	Das S. Association of Dietary Calcium Intake and Cardiovascular Markers in Healthy Postmenopausal Women [Master's thesis]. McGill University; August 2018.
2013	Gaddini GW. Effects of 12 Months of Voluntary Alcohol Self-Administration on Intracortical Bone Remodeling in a Rhesus Macaque Model [Master's thesis]. Oregon State University; 2013.
2013	Rubin KH. The Use of Risk Assessment Tools in the Clinical Management of Osteoporosis [PhD thesis]. University of Southern Denmark (SDU); July 2013.
2009	Varga P. Prediction of Distal Radius Fracture Load Using HR-PQCT-Based Finite Element Analysis [PhD thesis]. Vienna University of Technology; December 2009.