Low bone mineral density and impaired bone metabolism in young alcoholic patients without liver cirrhosis: a cross-sectional study.
BACKGROUND
Osteoporosis is regularly mentioned as a consequence of alcoholism. Ethanol's direct effect on bone-modeling cells as well as alcoholism-related "life-style factors" such as malnutrition, lack of exercise, hormonal changes, and liver cirrhosis are discussed as potential causative factors.


METHODS
In a cross-sectional study, we have examined 57 noncirrhotic alcoholic patients (37 male, 20 female) aged 27 to 50 years. Patients suffering from comorbid somatic diseases and with co-medication known to have an influence on bone mineral density (e.g., glucocorticoids, heparin, anticonvulsant agents, oral contraceptives) were excluded. We determined bone mineral density (BMD) by dual x-ray absorptiometry (DXA) in the lumbar spine (L1-L4) and the proximal right femur (femoral neck, total hip) as well as parameters of bone metabolism.


RESULTS
In males but not females, BMD was significantly reduced in the lumbar region, as well as in the proximal femur (femoral neck, total hip). Nine male patients (24.3% of men) and 1 female patient (5% of women) had low BMD (defined as Z-score < or = -2.0). As expected, there was a positive correlation between body mass index (BMI) and BMD. Alcohol-related factors (e.g., duration of abuse, consumed amount of alcohol per day) as well as smoking were not associated with a significant effect on BMD. All of the 20 women examined showed elevated estradiol levels, which may have served as a protective factor. In this study, 75.7% of the men and 90% of the women had vitamin D insufficiency or deficiency (plasma levels of 25-hydroxy-vitamin D < 30 ng/ml).


CONCLUSIONS
Our study indicates that younger alcoholic patients without other diseases may suffer from an increased risk to develop low BMD and a disturbance of vitamin D metabolism. Nutritional factors or less exposure to sunlight may play an important role in bone loss in young alcoholic patients. BMD measurement and assessment of bone metabolism should be considered in all patients with chronic alcoholism.
Malik
Peter
P
Department of Biological Psychiatry, Medical University Innsbruck, Anichstrasse 35, Innsbruck, Austria. peter.malik@i-med.ac.at
Gasser
Rudolf W
RW
Kemmler
Georg
G
Moncayo
Roy
R
Finkenstedt
Gerd
G
Kurz
Martin
M
Fleischhacker
W Wolfgang
WW
D015502:Absorptiometry, Photon; D000328:Adult; D000437:Alcoholism / Q000378:metabolism* / Q000473:pathology*; D015415:Biomarkers; D015519:Bone Density / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000378:metabolism; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012727:Sex Characteristics; D012907:Smoking / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000139:chemically induced / Q000453:epidemiology / Q000378:metabolism
D015415:Biomarkers