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Moderate alcohol consumption and increased bone mineral density: potential ethanol and non-ethanol mechanisms
Summary: The authors state that mounting epidemiological evidence indicates an association between the moderate ingestion of alcoholic beverages (versus abstinence) and higher bone mineral density. More limited findings provide some evidence for translation of this association into reduced fracture risk, but further studies are required. Here, these data are reviewed and caveats in their assimilation, comparison and interpretation as well as in the use and application of bone health indices are discussed.

Whilst it is concluded that evidence is now strong for the moderate alcohol-bone health association, at least in relation to bone mineral density, mechanisms are less clear. Both ethanol and non-ethanol components have been implicated as factors that positively affect bone health in the light-to-moderate consumption of alcoholic beverages, and four particular areas are discussed. First, recent findings suggest that moderate ethanol consumption acutely inhibits bone resorption, in a non-parathyroid hormone- and non-calcitonin-dependent fashion, which can only partly be attributed to an energy effect. Second, critical review of the literature does not support a role for moderate ethanol consumption affecting estrogen status and leading to a knock-on effect on bone. Third, silicon is present at high levels in certain alcoholic beverages, especially beer, and may have a measurable role in promoting bone formation. Fourth, a large body of work indicates that phytochemicals (e.g., polyphenols) from alcoholic beverages could influence bone health, but human data are lacking. With further work it is hoped to be able to model epidemiological observations and provide a clear pathway between the magnitude of association and the relative contribution of these mechanisms for the major classes of alcoholic beverage.

Comments: This is a thorough review article on the relation of alcohol consumption to bone mineral density. The authors conclude that alcoholic beverages may indeed increase bone mineral density (BMD), although the data are inconclusive regarding its impact on the risk of fracture. The biological mechanisms are not well understood, but the suppression of bone resorption by alcohol is suspected as one important factor. The authors also state that silicon, an element that is in high concentration in many beers, may be associated with BMD, but some human studies have shown beneficial effects only in pre-menopausal, but not in post-menopausal, women.

Lay Summary: This review of alcohol and bone mineral density (BMD) concludes that alcoholic beverages may, indeed, have a favorable effect on BMD, a measure of osteoporosis. The association of alcohol intake with fractures is less well defined.

Article: Jugdaohsingh R, O’Connell M, Sripanyakorn S, Powell J. Moderate alcohol consumption and increased bone mineral density: potential ethanol and non-ethanol mechanisms. Proc Nutr Soc 2006;65:291-310.

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