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Critique 161: The effects of alcohol consumption on the risk of hip fracture — 31 March 2015

Among elderly people, falls leading to hip fracture are a major health problem, leading to severe morbidity and mortality. Underlying factors that increase the risk of hip and other fractures include osteoporosis and low bone mineral density, as well as an unsteady gait making falls more common. The role that alcohol consumption among the elderly may relate to hip fracture has been a topic of concern for many decades, but data from a number of prospective studies now suggest that light-to-moderate drinking may actually decrease the risk of such fractures, while heavy drinking may increase the risk.

The present meta-analysis is based on prospective studies that have yielded more than 26,000 incidences of hip fracture. It concludes that there is a “J-shaped” association between alcohol consumption, especially of wine, and the risk of hip fractures, with lower risk for a reported consumption of about 1 drink/day, no effect from drinking between 1 and 4 to 5 drinks, and an increased risk from heavier drinking. Part of the “protection” from light drinking is apparently from the effects of alcohol on increasing bone mineral density.

Forum reviewers considered this to be a very well-done meta-analysis that provides balanced information on the risk of this common public health problem. Noting that the major differences seen in this study were between light drinkers and heavy drinkers, it was commented that there are many differences between people who are moderate in their habits, including moderate drinking, and people who usually consume more than 4 or 5 drinks/day; thus, there is still the possibility of other lifestyle factors confounding this association. Also, it was noted that most of the subjects in this analysis were North American or European, so applicability to other racial/ethnic groups may be limited.

In summary, this large and very well-done meta-analysis supports a protective effect of light alcohol consumption on the risk of hip fracture, with an increase in bone density from alcohol being a probable important factor. Data suggest that wine consumption may have the most favorable effect, perhaps indicating that polyphenols and other compounds may also play a role. The study shows that heavy drinking (an average of 4 to 5 or more drinks/day) is associated with an increase in the risk of hip fracture.

Reference: Zhang X, Yu Z, Yu M, Qu X. Alcohol consumption and hip fracture risk. Osteoporos Int 2015;26:531–542. DOI 10.1007/s00198-014-2879-y

For the full critique of this paper by members of the International Scientific Forum on Alcohol Research, please click here.

 
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