title: Effect of a comprehensive lifestyle modification program on the bone density of male heavy drinkers.
abstract: BACKGROUND
  Heavy alcohol drinking is implicated in osteoporosis. Although abstinence is rapidly followed by a restoration of osteoblastic activity, little is known about the contributions of alcohol-related factors or the effectiveness of a lifestyle modification program (LMP) on bone density.
  
  
  METHODS
  We conducted a study of 138 male alcoholic patients to investigate whether drinking history and concurrent factors were associated with the bone density of the calcaneus. A 2.5-months LMP in an institutionalized setting was completed by 20 of them, and its effect on bone density, serum parathyroid hormone (PTH), and 1.25-(OH)(2) vitamin D levels were assessed.
  
  
  RESULTS
  The patients had a high prevalence of daytime drinking (93.5%), continuous drinking (84.1%), and current smoking (82.0%) with mean duration of alcohol abuse of 30.0 +/- 12.8 years. The patients had lower bone density than a reference control group (Z-scores: -0.45 +/- 1.02). Multiple stepwise regression analysis identified age, poor activities of daily living (ADL), continuous drinking, absence of liver cirrhosis, depression, and dementia as determinants of low bone density. The bone density of the 20 participants in the LMP improved 2.3% (p = 0.0003) with a more ameliorating effect on bone density than a conventional abstinence therapy (p = 0.014 for interventional effect). The upper normal range of PTH levels at baseline were significantly decreased, and 1.25-(OH)(2) vitamin D levels also had a trend toward decrease during the abstinence.
  
  
  CONCLUSIONS
  Alcoholic patients may have many complications such as poor ADL and dementia, which are independently associated with decreased bone density. The results of this study support the idea that comprehensive approach to lifestyle factors to minimize risk of osteoporosis is the best way to improve bone density.
authors.affiliation: National Hospital Organization Kurihama Alcoholism Center, Kanagawa, Japan. t_matsui@kurihama1.hosp <t_matsui@kurihama1.hosp>
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Matsui
authors.forename: Akira
authors.initials: A
authors.lastname: Yokoyama
authors.forename: Sachio
authors.initials: S
authors.lastname: Matsushita
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Ogawa
authors.forename: Shuka
authors.initials: S
authors.lastname: Mori
authors.forename: Emiko
authors.initials: E
authors.lastname: Hayashi
authors.forename: Sungwon
authors.initials: S
authors.lastname: Roh
authors.forename: Susumu
authors.initials: S
authors.lastname: Higuchi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Arai
authors.forename: Katsuya
authors.initials: K
authors.lastname: Maruyama
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D015519:Bone Density / Q000187:drug effects / Q000502:physiology; D004035:Diet Therapy / Q000379:methods; D015444:Exercise / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control*; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior; D013695:Temperance