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"A little but not a lot" is the rule for alcohol and bone health. A little alcohol on a regular basis improves bone density, but heavy drinking accelerates osteoporosis. Even if you can’t control drinking, there are measures that help preserve your bones.

Alcohol has a paradoxical relationship with osteoporosis. People who drink, on average, just one drink every other day to as much as one drink a day tend to have higher bone mineral density than people who drink infrequently or don’t drink at all. Drinking red wine, in particular, helps to prevent osteoporosis. But drinking excessively increases the demineralization that makes bones brittle.

How much alcohol is in one “drink”?

The US Centers for Disease Control defines a drink as 14 g (or 17.7 ml) of pure ethanol. That’s the amount of alcohol found in:

  • 12 fluid ounces (360 ml) of beer,
  • 8 fluid ounces (240 ml) of malt liquor,
  • 5 fluid ounces (150 ml) of wine, or
  • 1.5 fluid ounces (45 ml) of liquor.

What are low, moderate, and heavy consumption of alcohol?

  • Low consumption of alcohol is drinking on an infrequent basis (less than three times a week) or not drinking at all.
  • Moderate consumption of alcohol is drinking less than one drink a day for women or less than two drinks a day for men three or more days a week.
  • Heavy consumption of alcohol, for purposes of estimating the risk of osteoporosis, is drinking more than one drink a day every day for women or more than two drinks a day for men or drinking more than five drinks in one drinking binge.

What is the relationship between alcohol and bone health?

Healthy bones are constantly remodeling themselves to accommodate changes in weight, tension from ligaments and tendons, and tiny, microscopic breaks known as microfractures. Specialized cells known as osteoclasts break down old bone in a process called resorption. Other specialized cells known as osteoblasts build new bone in a process called formation. Demineralization of bone can occur when:

  • Elevated bone remodeling, high turnover of bone, when resorption increases but formation stays the same.
  • Uncoupled bone remodeling, uncoupled turnover of bone, when resorption and formation get out of sync.
  • Reduced bone remodeling, low turnover of bone, when both resorption and formation slow down but resorption still outpaces formation.

Uncoupled turnover of bone, when the two processes get out of sync, can result in osteoporosis in just a few months. In heavy drinkers who do not have pancreatitis or liver disease the greater problem is low turnover of bone, which demineralizes bones over a period of years or even decades. When people drink all the time, it is as if the cells that recycle bone and the cells that make new bone have a perpetual hangover, but the hangover is worse for the bone makers than it is for the bone breakers.

Osteoporosis caused by excessive drinking is reversible

The good news for people who have both alcohol issues and osteoporosis is that the osteoporosis is reversible. In one clinical trial, women who were moderate drinkers showed an increase in the biochemical markers of bone formation after abstaining from alcohol for two weeks. In another clinical trial, alcoholic men who had cirrhosis of the liver showed a normalization of the markers of bone formation in just two weeks of avoiding drink. In young adults, the effects of alcohol on bone formation can be reversed in just a few hours of abstinence. However, restoring bone to normal mineral content takes more than just stopping booze.

  • Most people who have alcohol-related osteoporosis need to eat more. People who abuse alcohol typically have issues with nutrition because alcohol replaces healthy foods. The effects of alcohol on bone nutrition (in laboratory studies) are observable when the calories from alcohol exceeds more than 3 percent of the total calories in the diet. That’s the equivalent of one drink every other day on a 2,000 calorie-a-day diet. People who consume more than about 12 percent of their calories in the form of alcohol (the equivalent of 3 or more drinks a day on a 2,000 calorie-a-day diet) experience appetite suppression and are less likely to be obese and more likely to be thin — and suffer osteoporosis.
  • Most people who have alcohol-related osteoporosis need more magnesium. Magnesium is more likely to be deficient than calcium in people who drink moderately or more. Bone needs magnesium to absorb calcium. Magnesium is essential for the secretion of parathyroid hormone. When there parathyroid hormone is lacking, calcium is excreted into the urine rather than made available to bones. (It can become kidney stones rather than heathy bone.) Deficiency of parathyroid hormone deficiency can set up a downward spiral in which the depletion of magnesium leads to the depletion of parathyroid hormone and the depletion of parathyroid hormone leads to further depletion of magnesium. Magnesium is also involved in steps that get vitamin D in active form in the bloodstream.
  • Anyone who has liver disease is probably deficient in vitamin D. Supplemental vitamin D is a must for people who have cirrhosis or elevated liver enzymes. The liver makes binding protein that carries vitamin D through the bloodstream. When production of the binding protein is sporadic because the liver is sick, then the availability of vitamin D has to be constant to take advantage of all the carrier compound that the liver can create.

Booze and bones: One form of booze is good for your bones — in moderation

All forms of alcohol are not equally detrimental to your bones. Red wine in moderate amounts, one to three glasses a week for women and two to six glasses a week for men if no other forms of alcohol are consumed, is helpful in maintaining bone density. Red wines that are higher in tannins are healthier for bones, and people whose digestive tracts contain probiotic bacteria are better able to absorb the healing compounds in red wine.

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