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Alcohol-And Drug-Induced Osteoporosis

Medically reviewed by

Dr. Gerardo Sison, Pharm.D

Osteoporosis is a bone disorder characterized by low bone mass, increased bone fragility, and increased likelihood of bone fracture. This disorder can be cause and made worse with excess alcohol or drug intake.

Alcohol- And Drug- Induced Osteoporosis

Osteoporosis is a bone disorder characterized by low bone mass, increased bone fragility, and increased likelihood of bone fracture. Depending on its underlying causes, osteoporosis may be classified as primary or secondary. Primary osteoporosis is caused by aging, menopause and decline in estrogen levels.

Secondary osteoporosis is caused by specific conditions, such as disease, surgery or excess alcohol or drug intake. Roughly one in two women and one in eight men over the age of 50 will develop osteoporosis and experience an osteoporosis-related fracture in their lifetime. According to the National Institutes of Health, these fractures account for about $14 billion USD in direct medical costs per year.

It is estimated that nearly 44 million American adults are affected by osteoporosis. Possible factors that may increase someone’s likelihood of developing the disease include:

  • drinking too much alcohol
  • prolonged use of certain medications
  • smoking cigarettes
  • having a small frame or being too thin
  • family history of osteoporosis
  • being postmenopausal
  • experiencing early menopause
  • not having regular menstrual periods
  • not getting enough calcium
  • not participating in regular physical activity

Alcohol-Induced Osteoporosis

Research has indicated that chronic, heavy drinking can cause hormone deficiencies in both men and women. Men with alcohol use disorders may produce less testosterone, which is a hormone that has been shown to aid in the production of osteoblasts (cells that stimulate bone formation.)

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Women who suffer from alcohol use disorders often experience irregular menstrual cycles. This reduces estrogen levels and increases the risk of osteoporosis. Individuals who struggle with alcoholism are also known to have increased levels of the cortisol hormone, which is associated with a decrease in bone formation and an increase in the rate of bone decomposition.

Alcohol can negatively impact bone health in several ways, including:

  • interfering with calcium levels in the body (necessary for bone development)
  • increasing parathyroid hormone (PTH) levels (reduces calcium reserves)
  • interfering with the production of vitamins essential for calcium absorption

How Does Alcohol Harm Bones?

When someone drinks too much alcohol, about two to three ounces a day, it interferes with the way the stomach absorbs calcium from the food they eat. Once digested, alcohol interferes with how the pancreas absorbs calcium and vitamin D. Alcohol has also been shown to negatively affect the liver, which plays a vital role in activating vitamin D for bone formation and overall vitamin D absorption.

Drinking And Increased Risk Of Bone Fracture

Individuals who participate in regular, heavy drinking have been linked to more incidents of bone fracture than those who consume moderate amounts of alcohol or abstain from alcohol consumption. This increased occurrence of fractures is due to brittle bones and nerve damage, which are a result of alcohol abuse.

It is most likely for fractures to occur in the hip or spine. Fractures suffered in these parts of the body are likely to heal slowly because of the malnutrition often caused by alcohol use disorders.

Increased Risk For Developing Alcohol-Induced Osteoporosis In Women

Humans usually reach their peak bone mass by age 35. From then on, women in particular slowly lose bone mass until a few years after menopause (when the loss of bone mass is greatly increased.) For middle-aged and older women, how healthy their bones are depends on how well-developed they were during their youth.

Research indicates that chronic, heavy drinking, especially during adolescence and young adult years, can dramatically impact bone quality and may increase the risk of osteoporosis. It has also been noted that the damage to bones caused by alcohol cannot be reversed, even if alcohol consumption is stopped.

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Drug-Induced Osteoporosis

One of the lesser-known factors that may contribute to the development of osteoporosis is the use of certain medications. Although there is limited information on how specific medications can affect bone health, research has noted a few common medications that do, including:

  • corticosteroids (steroids used to treat inflammation)
  • antidepressants
  • anticonvulsants
  • progestins (hormones commonly used in many forms of birth control)

Corticosteroids (anti-inflammatory steroids)

This type of medication is the most common secondary cause of osteoporosis and the third overall cause. Glucocorticoids (a type of corticosteroid) are widely used as an effective treatment for pulmonary, rheumatological, gastrointestinal, dermatologic and autoimmune conditions.

The first six to 12 months of therapy with these types of medications is when the risk of bone loss is greatest. Many studies that have examined steroid-induced osteoporosis have concluded that 30 to 50 percent of people taking systemic, long-term steroids will eventually experience a bone fracture.

Antidepressants

The hormone serotonin plays an important role in bone physiology. Serotonin aids in the communication of parathyroid hormone from the brain to the osteoblasts and osteocytes (cells in the bones). Several different studies have noted significant bone loss in individuals who were long-time users of serotonin-reuptake inhibitors (SSRI) for depression.

The link between antidepressant use and fractures is well-established, however, more recent research indicates that major depressive disorder itself may be associated with decreased bone mass density and increased bone fracture risk.

Anticonvulsants

There are a handful of different ways anticonvulsants may affect bone metabolism. Initially, it was thought that anticonvulsants quickly ate through vitamin D reserves, which would lead to decreased vitamin D availability for the absorption of calcium. Decreased calcium absorption would then cause an increase in parathyroid hormone and increase the rate of bone turnover.

The additional ways anticonvulsants affect bone metabolism are poorly understood. Although, animal studies suggest that these medications directly inhibit bone cells and gastrointestinal calcium absorption.

Progestins (hormones included in birth control)

Progestins are a type of hormone used in different types of contraception and hormone replacement therapies. These medications may be used by a wide age-range of women. The type of progestin most commonly associated with bone loss is the medroxyprogesterone acetate (MPA). Medications that use MPA include: Depo-Provera (injectable birth control) and Premphase and Prempro (hormone replacement therapies.)

Effects of MPAs on bone mass depend on the size of the dose and the estrogen levels of the individual taking the medication. It is not advised to take these medications for more than two years at a time, as the long-term effects of each medication have been associated with severe bone mass loss later in life.

Can Tobacco Use Contribute To Osteoporosis?

Tobacco directly affects bone cells and interferes with their ability to function. Many studies have linked heavy tobacco use to decreased bone health, including:

  • increased risk of osteoporosis
  • lower bone density
  • higher rate of bone fractures
  • fewer teeth
  • dramatic decrease in mineralization of bones in the hip, hands, forearms and heels
  • decreased bone healing
  • decreased new-bone formation

Studies of postmenopausal women smokers show about a 50 percent increased loss in cortical bone (tubular, mid-shaft bone) compared to their non-smoking counterparts. Smoking may also speed-up the breakdown rate of the estrogen hormone in postmenopausal women, resulting in increased loss of bone mass and increased likelihood of bone fracture.

Alcohol- And Drug-Induced Osteoporosis Prevention And Management

Osteoporosis is a serious illness, however, it may be possible in some cases for bone loss to be halted or possibly reversed with the following practices:

  • Quitting smoking and use of certain drugs.
  • Getting a bone density test. (The results from this test can help nutritionists determine how much vitamin D, K, B12, folic acid and calcium are needed to restore bone.)
  • Beginning an exercise program, such as walking, cycling or weight-lifting.
  • Drinking green tea instead of coffee.
  • Performing daily pH test to monitor pH levels, as acidity in the body has been linked to increased bone loss.

Adequate intake of calcium and vitamin D through diet and other sources is important for bone health. The recommended dose of calcium for people between 19 and 50 years of age is about 1,000 mg/day. For people 50 and older, the recommended dose is between 1,200 and 1,500 mg/day. If a calcium supplement is being used, it should not exceed more than 500 mg at once, as this is the maximum amount the body can readily absorb at any given time.

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Vitamin D requirements can be met through exposure to sunlight (at least 15 minutes per day), diet or supplements. Recommended daily intake of vitamin D is between 400 and 800 IU (international units). Individuals with kidney damage or limited kidney function may need lower doses of vitamin D.

It is always best to consult with a healthcare professional prior to starting a new supplement regimen.

Alcohol And Drug Abuse Treatment

Osteoporosis is a silent disease that is often preventable. Because symptoms of osteoporosis are difficult to detect, it can progress for many years until a fracture occurs. Getting yearly bone mass assessments can help doctors determine if osteoporosis is present.

Alcohol- and drug-induced osteoporosis is manageable with the proper care. It is important to talk openly about any alcohol or drug abuse, as it may affect bone health. Without this information bone loss can be easier to overlook.

For more information on alcohol- and drug-induced osteoporosis, contact a specialist today.

American College of Clinical Pharmacy - https://www.accp.com/docs/bookstore/psap/p7b03.sample04.pdf

National Center for Biotechnology Information - https://www.ncbi.nlm.nih.gov/pubmed/24138635

Medically reviewed by

Dr. Gerardo Sison, Pharm.D
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