Alcohol and Bone Health: How Your Drinking Affects Bone Density and Strength

By Laura Yecies, CEO @ Osteoboost.

It’s Friday at 5 p.m., and your coworkers are headed out for a few drinks to blow off steam. Or it’s Sunday afternoon and the carafe of mimosas is brought to the table. But you hesitate. Your doctor says you have osteopenia. What are the risks of drinking alcohol with low bone density? 

Let’s dive into the science and see if we can’t add some clarity to the debate.

Why is bone health so important, especially after menopause?

The stronger you keep your bones, the better your chances to have a rich, active life into your golden years. Mobility, independence are big factors when it comes to your quality of life. 

Conditions like osteopenia and osteoporosis weaken bones, increasing the risk of fractures. While many factors like menopause contribute to bone concerns, alcohol consumption is a modifiable lifestyle factor that plays a significant role—for better and worse. Understanding how alcohol affects bone density and strength can help you make informed decisions for long-term skeletal health.

The Link Between Alcohol and Bone Density

Bone density refers to the amount of bone mineral in bone tissue, a critical factor in determining bone strength. Osteopenia, a precursor to osteoporosis, involves lower-than-normal bone density and puts individuals at risk for fractures. Studies show that excessive alcohol consumption can negatively affect bone density through several mechanisms:

• Inhibition of Bone Formation: Chronic alcohol use suppresses osteoblast activity—the cells responsible for bone formation—leading to a reduction in bone mass.
• Nutritional Deficiencies: Alcohol interferes with the absorption of essential nutrients like calcium and vitamin D, both critical for bone health.  Often alcohol calories replace calories that are needed for important nutrients such as protein and calcium.
• Hormonal Imbalances: Excessive drinking disrupts hormone levels, including estrogen and testosterone, which are essential for maintaining bone density. Estrogen deficiency, particularly in postmenopausal women, exacerbates bone loss.
• Increased Bone Resorption: Alcohol can stimulate osteoclast activity—the cells that break down bone tissue—leading to accelerated bone loss.

FRAX and Alcohol

The FRAX fracture risk assessment tool identifies consumption of more than 2 units of alcohol as a risk factor for fracture.  Depending on your age and BMD the fracture risk is projected to increase by 20-25 percent holding all other risk factors constant.  This is a huge difference – especially for something that is a controllable risk factor.  It is interesting to note that this risk increase is greater than the increase from smoking.

Alcohol, Balance, and Fall Risk

Beyond its direct effects on bone density, alcohol consumption increases the risk of falls, a significant concern for individuals with osteopenia or osteoporosis. Impaired balance, coordination, and judgment are common even after moderate drinking, leading to a higher likelihood of accidents and fractures. According to the Journal of Bone and Mineral Research, approximately 90% of hip fractures in older adults result from falls.

• Impaired Coordination: Alcohol affects the cerebellum, the part of the brain responsible for balance and coordination, making falls more likely.
• Weakened Reflexes: Slower reaction times increase the severity of falls, often resulting in more serious injuries.
• Environmental Hazards: Alcohol consumption can also make individuals less aware of environmental risks, such as uneven surfaces or slippery floors.

For people at risk of osteoporosis, the consequences of a fall can be life-altering. Fractures, especially of the hip or spine, often lead to long-term disability or reduced life expectancy.

Moderate Alcohol Consumption: Is There a Positive Side?

We have been experiencing a transition regarding the view of alcohol.  For instance, there have been studies showing alcohol, in particular red wine, having a positive effect on cardiovascular disease.  There have also been studies linking moderate alcohol consumption to a protective effect on bone density.  Research published in Menopause: The Journal of The North American Menopause Society found that moderate alcohol intake (about one drink per day for women and two for men) is associated with higher bone density compared to heavy drinking or complete abstinence. The potential benefits include:

• Bone Remodeling: Moderate alcohol intake may support balanced bone remodeling by mildly stimulating osteoblast activity.
• Cardiovascular Benefits: Moderate drinking is linked to better cardiovascular health, which indirectly supports bone health by improving nutrient delivery to bone tissue. The presence of polyphenols in red wine, may have antioxidant and anti-inflammatory properties that are beneficial to bone health.  However, it is now hypothesized that much of the observed cardiovascular benefit was from the Mediterranean diet, which often includes red wine but also includes a number of health-promoting foods and lifestyle. 

These potential benefits must be weighed against individual risk factors, such as age, sex, medical history, and overall lifestyle.  Given the limited positive data on modest consumption and the strong negative bone health data on heavy consumption, the increased fall risk as well as the increased cancer risk, we can’t in good conscience recommend alcohol for bone health.  

Strategies for Protecting Bone Health

If you’re concerned about your bone health, consider these strategies:

1. Limit Alcohol Intake: Follow guidelines recommending no more than one drink per day. Individuals with osteopenia or osteoporosis may benefit from avoiding daily drinking and only having a drink on special occasions.
2. Focus on Nutrition: Ensure adequate intake of calcium (1,000-1,200 mg/day) and vitamin D (800-1,000 IU/day).  Alcohol disrupts nutrient absorption, so prioritizing a nutrient-rich diet is essential.
3. Exercise Regularly: Weight-bearing and resistance exercises stimulate bone formation and improve balance, reducing the risk of falls.
4. Address Underlying Health Issues: Conditions like liver disease, which are often exacerbated by alcohol, can further compromise bone health.
5. Modify Your Environment: Reduce fall risks by installing grab bars, improving lighting, and securing rugs or loose wires.
6. Consider non-pharmacological solutions like Osteoboost to protect your bone health :).

Takeaways

What does this all mean, practically speaking?

By understanding the interplay between alcohol and bone health, you can take proactive steps to protect your bones and reduce the risk of debilitating fractures. Small changes today can make a significant difference for your future health.

The answer is not one-size-fits-all. We know many of our Osteoboosters already struggle with bone density, so caution is warranted. We’re also not going to admonish anyone for having a glass of champagne at your grandchild’s wedding or the occasional red wine with a good steak dinner, at least not from the perspective of bone health. 

And it’s important to know your risks beyond just your bone density – including interactions with medications, predisposition to addiction, and other medical conditions that are impacted by alcohol. Talk to your doctor to determine the best plan for you.

References

1. Kanis, J. A., et al. (2008). “Alcohol intake as a risk factor for fracture.” Osteoporosis International, 19(5), 681-689. DOI:10.1007/s00198-007-0462-0.
2. Tucker, K. L., et al. (2009). “Effects of beer, wine, and liquor intakes on bone mineral density in older men and women.” American Journal of Clinical Nutrition, 89(4), 1188-1196. DOI: 10.3945/ajcn.2008.26765.
3. Maurel, D. B., et al. (2012). “Alcohol and bone: review of dose effects and mechanisms.” Osteoporosis International, 23(1), 1-16. DOI:10.1007/s00198-011-1787-7.
4. Cummings, S. R., & Melton, L. J. (2002). “Epidemiology and outcomes of osteoporotic fractures.” The Lancet, 359(9319), 1761-1767. DOI:10.1016/S0140-6736(02)08657-9.