Boosting Bone Density After 35: Alcohol is Bad to the Bone

The importance of maintaining strong bone health cannot be overstated when it comes to our longevity and a high quality of life in old age. Bone health is a critical aspect of overall wellness, yet it’s often overlooked until a problem arises.

Osteoporosis, characterized by weakened and brittle bones, affects millions worldwide and significantly increases the risk of fractures.

While calcium and vitamin D are commonly discussed in the context of bone health, the impact of alcohol consumption often flies under the radar.

Why Understanding Bone Health Matters Most for Adults Over 35

• Over 2.3 million Canadians are living with osteoporosis. At least 1 in 3 women and 1 in 5 men will suffer from an osteoporotic fracture during their lifetime [5].
• Fractures from osteoporosis are more common than heart attack, stroke and breast cancer combined. The risk of having a major osteoporotic fracture in Canada is among the highest in the world – in the top quarter. [8]
• In Canada, 10% of adults aged > 40 years and 21% of post-menopausal women have osteoporosis. [9]
• Over 80% of fractures in people 50+ are caused by osteoporosis [5]. A study conducted in Manitoba in 2010 found that 22% of women and 33% of men who suffer a hip fracture will die within one year [6].
• Bone grows and peaks at 30 - 35; then we begin to lose bone density each year through bone remodeling [12]. In other words, the intervention after 30 focuses on slowing down the loss of bone density. This underscores the importance of adequate nutrition and physical activities for bone health before 30, especially during adolescence and healthy behavior after 35.

What Is Bone?

Bone comprises a protein matrix, collagen and minerals [2]. Most importantly, calcium, calcitriol (vitD3), Magnesium and Vitamin K are the key players in bone health [11].

Why Do We Need Bone?

Bone provides skeletal support, protects soft organs, facilitates movements and houses bone marrow which makes red blood cells [2].

How Do Bones Stay Strong?

Our bones grow and develop throughout childhood and adolescence, reaching their peak density between the ages of 30 and 35. After that, bone mass begins to gradually decline each year through a biological process called remodeling.

Bones are living tissue, constantly being broken down and rebuilt in the remodeling process; influenced by hormones, age and nutritional status. A healthy balance in the remodeling process is essential for maintaining bone density and strength.

Bone remodeling happens in 3 phrases [4][7]:

• Resorption: osteoclast breaks down old bone.
• Reversal: mononuclear cells appear on the bone surface, further degrade the demineralized bone matrix left on the resorbed surfaces and forming reversal lines.
• Formation: osteoblast build up new bone to replace the degraded one.

This cycle runs continuously and bone density declines each time it happens; the older we get, the more bone density we will lose.

To maintain strong bones, adequate nutrition and regular physical activity are vital not only during the early stages of life but also throughout adulthood.

Why Bone Health Differs Between Men and Women: The Role of Menopause

Contrary to popular belief, estrogen is not just a female hormone. Studies show that estrogen is the key hormone in bone metabolism in both men and women.

Estrogen inhibits osteoclast, preventing bone breakdown. Likewise, testosterone exerts an additional action by stimulating the apposition of the periosteum, thereby accounting for the larger size and increased thickness of the cortex of the male skeleton.

As estrogen decreases with age, researchers have noticed an increased rate of bone loss over time. Moreover, the lack of estrogen seen in menopausal women is associated with a drastic decrease in bone loss, contrary to men who lose bone gradually and steadily as they age [13] [14].

On the other hand, a reduction in testosterone in men has also been shown to be associated with an increased rate of osteoporosis, yet testosterone’s effect on women concerning bone health remains unclear [14].

What is osteoporosis?

Osteoporosis is a reduction in bone density, leading to fragile bone and increased fracture risk.

Primary osteoporosis happens naturally with aging and hormonal changes, whereas secondary osteoporosis happens due to other diseases such as Crohn’s disease, celiac disease, malabsorption disorders or IBD [16].

Fractures happen most often in the hip, forearm and spine [18].

What are the risk factors for osteoporosis? [8]

Age Related Osteoporosis Risk Factors:

• We start losing bone density naturally from 30 or 35 years old.
• Women see an increase in bone density loss after menopause, as decreasing estrogen decreases bone formation yet increases bone breakdown.
• Men see an increase in bone density loss after 65.

Sex Related Osteoporosis Risk Factors:

• Even though osteoporosis affects both women and men, women are at higher risk of osteoporosis for reasons explained above.

Diet Related Osteoporosis Risk Factors:

• Low calcium and Vitamin D intake can put us at risk.
• Consistent low calcium intake is associated with an increased risk of osteoporosis and Vitamin D is essential for Calcium absorption. By default, low vitamin D intake is associated with a decrease in calcium, consequently, weakening bones.

Alcohol Related Osteoporosis Risk Factors:

• Research shows an increased risk of osteoporosis for those who regularly consume 3 or more alcoholic drinks per day. Increased alcohol intake also contributes to increased risk for falls and is often associated with poor nutrition. [1]

Inactive Lifestyle Related Osteoporosis Risk Factors:

• Lack of exercise is associated with low bone density.
• Being physically active (aerobic exercise, cardio, etc.) helps protect your spine and slows the rate of bone loss.
• Workouts that focus on muscle building like weight lifting or resistance training help build strength, improve balance and prevent falls.

Medications Related Osteoporosis Risk Factors:

• Some medications inhibit Calcium absorption like heartburn medications, breast cancer medications, blood pressure medications, etc., which can increase the risk of osteoporosis.
• Find out the full list of medications here.

Medical Condition Related Osteoporosis Risk Factors:

• Conditions such as liver disease, chronic kidney disease, diabetes, etc. are associated with an increased risk of falling, calcium malabsorption and low sex hormones essential for bone formation.
• Find out the full list of medical conditions here.

Family History Related Osteoporosis Risk Factors: 

• Having a family history of osteoporosis or parents who have a hip fracture put you at greater risk of developing one.

Take the Know Your Risk quiz by Osteoporosis Canada to find out what your risk might be.

How Bad Is Alcohol For Your Bone Health

Chronic alcohol intake has an enormous detrimental effect on bone growth and maintenance at any age.

Studies have found that alcohol increases bone resorption while decreasing bone formation. Moreover, excessive alcohol impairs the ability of the parathyroid gland to secret PTH in response to low calcium levels [26].

Alcoholic men often have decreased levels of testosterone, and female alcoholics experience an increased metabolic conversion of testosterone to estradiol [27]. This suggests that heavy alcohol usage may lower estrogen levels.

Since estrogen deficiency is a major factor in osteoporosis development, alcohol might be responsible for osteoblastic dysfunction, resulting in impaired bone growth and mineralization.

Although the adverse impacts of drinking on bone are most evident in young people, research has found that women between the ages of 67 and 90 who consumed an average of more than 3 ounces of alcohol per day (the equivalent of six drinks) had higher bone loss than women who had low alcohol intake [28].

Alcohol's impact on young, growing bone is particularly harmful since it diminishes peak bone mass and can lead to relatively fragile adult bones that are more prone to fracture.

Human and animal studies show that alcohol directly suppresses the activity of bone-forming cells.

Actions to Take to Improve Bone Density

Moderating alcohol intake is a great idea and consider the following recommendations from Osteoporosis Canada:

• Eating enough calcium daily. Check out the list of calcium sources here.
  • Female: 1000mg/day for aged 19 - 50, and 1200 mg/day for 50+.
  • Male: 1000mg/day for aged 19 - 70, and 1200mg/day for 70+.
• Getting enough vitamin D. Check out vitamin D sources here.
  • Adult aged < 70: 600 IU.
  • Adult aged > 70: 800 IU.
  • Health Canada recommended a supplement of 400UI for adults aged 51 and older.
  • Since vitamin D is a fat-soluble vitamin, toxication can occur if ingested in excess. Talk to your healthcare provider if you’re considering taking one.
• Eating enough magnesium and vitamin K mostly found in plant-based and leafy green produce.
• Eating enough protein. Check out protein sources here.
  • Adults need 0.8g of protein/kg of body weight. For example, if you weigh 60kg, you will need 60 x 0.8 = 48g of protein.
• Exercising
  • Balance and functional training twice a week. Examples include tai chi, squats and stair climbing.
  • Resistance training that increases muscle mass twice weekly, including exercises targeting abdominal and back extensor muscles. For example: plank, side plank, push-up and weight-lifting.
  • Check out this Too Fit to Fracture for more details about recommended exercise.

Resources to Help You Improve Your Bone Health

• Osteoporosis Canada
• Health Canada
• Should I have a DXA test?
• Aging well: Making your home fall-proof
• 7 tips to keep your bones strong
• Getting enough Calcium and vitamin D
• Am I eating well for my bones?
• Patient eligibility for OHIP funded bone density examinations
• Exercise for bone health
• Too fit to fracture
• Making a plan to cut back on alcohol use
• Canada’s Guidance on Alcohol and Health, Public Summary: Drinking Less Is Better

References

1. “Alcohol Intake and Bone Health: Osteoporosis Canada.” Osteoporosis Canada |, 20 Mar. 2023, osteoporosis.ca/position-statements/alcohol-intake-and-bone-health/.
2. “What Is Bone?” National Institute of Arthritis and Musculoskeletal and Skin Diseases, U.S. Department of Health and Human Services, 13 July 2023, www.niams.nih.gov/health-topics/what-bone.
3. “Office of Dietary Supplements - Calcium.” NIH Office of Dietary Supplements, U.S. Department of Health and Human Services, 2023, ods.od.nih.gov/factsheets/Calcium-Consumer/#.
4. Hadjidakis, Dimitrios J, and Ioannis I Androulakis. “Bone remodeling.” Annals of the New York Academy of Sciences vol. 1092 (2006): 385-96. doi:10.1196/annals.1365.035
5. 2022 Osteoporosis Canada Facts and Stats, 2022, osteoporosis.ca/wp-content/uploads/2022-Osteoporosis-Canada-Facts-and-Stats_Web.pdf
6. Morin, S et al. “Mortality rates after incident non-traumatic fractures in older men and women.” Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA vol. 22,9 (2011): 2439-48. doi:10.1007/s00198-010-1480-2
7. Domon, T et al. “The nature and function of mononuclear cells on the resorbed surfaces of bone in the reversal phase during remodeling.” Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft vol. 183,2 (2001): 103-10. doi:10.1016/S0940-9602(01)80027-3
8. “Risk Factors: Osteoporosis Canada.” Osteoporosis Canada |, 3 Dec. 2021, osteoporosis.ca/risk-factors/.
9. Kendler, D L et al. “A scorecard for osteoporosis in Canada and seven Canadian provinces.” Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA vol. 32,1 (2021): 123-132. doi:10.1007/s00198-020-05554-2
10. “Peak Bone Mass.” Wikipedia, Wikimedia Foundation, 16 Nov. 2024, en.wikipedia.org/wiki/Peak_bone_mass.
11. “Nutrition: Osteoporosis Canada.” Osteoporosis Canada |, 25 Oct. 2024, osteoporosis.ca/nutrition/.
12. “How to Keep Your Bones Healthy.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 3 Dec. 2022, www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/bone-health/art-20045060#.
13. Khosla, Sundeep et al. “Estrogen and the skeleton.” Trends in endocrinology and metabolism: TEM vol. 23,11 (2012): 576-81. doi:10.1016/j.tem.2012.03.008
14. Horstman, Astrid M et al. “The role of androgens and estrogens on healthy aging and longevity.” The journals of gerontology. Series A, Biological sciences and medical sciences vol. 67,11 (2012): 1140-52. doi:10.1093/gerona/gls068
15. Kauffman, Jonathan. “Why ‘got Milk?’ Is One of the Greatest Ad Campaigns of All Time.” Saveur, 1 Dec. 2022, www.saveur.com/culture/got-milk-greatest-ad-campaign/. 
16. Ratajczak, Alicja Ewa et al. “Milk and Dairy Products: Good or Bad for Human Bone? Practical Dietary Recommendations for the Prevention and Management of Osteoporosis.” Nutrients vol. 13,4 1329. 17 Apr. 2021, doi:10.3390/nu13041329
17. Sampson, H W. “Alcohol's harmful effects on bone.” Alcohol health and research world vol. 22,3 (1998): 190-4.
18. Yuan, Mengjie et al. “Types of dairy foods and risk of fragility fracture in the prospective Nurses' Health Study cohort.” The American journal of clinical nutrition vol. 118,6 (2023): 1172-1181. doi:10.1016/j.ajcnut.2023.09.015
19. Agency, Canadian Food Inspection. “Government of Canada.” Canadian Food Inspection Agency, / Gouvernement du Canada, 30 July 2024, inspection.canada.ca/en/food-labels/labelling/industry/nutrient-content/claims-reference-information#c1. 
20. Khazai, Natasha et al. “Calcium and vitamin D: skeletal and extraskeletal health.” Current rheumatology reports vol. 10,2 (2008): 110-7. doi:10.1007/s11926-008-0020-y
21. Canada, Health. Canada’s Food Guide, / Gouvernement du Canada, 2 Dec. 2024, food-guide.canada.ca/en/.
22. Thorning, Tanja Kongerslev et al. “Milk and dairy products: good or bad for human health? An assessment of the totality of scientific evidence.” Food & nutrition research vol. 60 32527. 22 Nov. 2016, doi:10.3402/fnr.v60.32527
23. Weaver, Connie M. “Calcium supplementation: is protecting against osteoporosis counter to protecting against cardiovascular disease?.” Current osteoporosis reports vol. 12,2 (2014): 211-8. doi:10.1007/s11914-014-0208-1
24. Hidayat, Khemayanto et al. “The Effects of Milk Supplementation on Bone Health Indices in Adults: A Meta-Analysis of Randomized Controlled Trials.” Advances in nutrition (Bethesda, Md.) vol. 13,4 (2022): 1186-1199. doi:10.1093/advances/nmab136
25. Zhang, Xingxia et al. “Milk consumption and multiple health outcomes: umbrella review of systematic reviews and meta-analyses in humans.” Nutrition & metabolism vol. 18,1 7. 7 Jan. 2021, doi:10.1186/s12986-020-00527-y
26. Sampson, H W. “Alcohol's harmful effects on bone.” Alcohol health and research world vol. 22,3 (1998): 190-4.
27. Diamond, T et al. “Ethanol reduces bone formation and may cause osteoporosis.” The American journal of medicine vol. 86,3 (1989): 282-8. doi:10.1016/0002-9343(89)90297-0
28. Sampson, H Wayne. “Alcohol and other factors affecting osteoporosis risk in women.” Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism vol. 26,4 (2002): 292-8.