The influence of alcohol on bone metabolism and fracture healing
Abstract: The influence of alcohol on bone metabolism, fracture and fracture healing was evaluated in men and male rats by measurements of bone mineral density (BMD), biochemical markers and biomechanical testings. Retrospectively, 199 male patients hospitalized for tibia shaft fractures were studied. Forty-nine were judged as problem drinkers. Abusers were more prone to sustain oblique fractures. The healing time was impaired in abusers who had sustained transverse fractures but this was not observed in oblique fractures. Cross-sectionally, 61 male patients treated for tibia shaft fractures were studied with respect to the degree of post-traumatic osteopenia. Twenty-four were judged as problem drinkers. In almost all measured regions of the lower extremities, the injured leg had a lower BMD. We were unable to identify an increase in post-traumatic bone loss among abusers, except for the femoral neck region. In two animal studies (male rats) we found a reduction in total bone mineral content in animals fed an alcohol liquid. By using biomechanical testings we were unable to identify any negative effects of alcohol on healing properties of induced tibia fractures and on post-traumatic bone changes. Cross-sectionally, we studied the effects of long-term alcohol withdrawal, at least 5 years, on BMD and biochemical markers. Abusers had reduced BMD, especially in the trochanteric region, and long-term abstinence tended to counteract this reduction. Furthermore, we found an imbalance between bone formation and bone resorption in abusers. Although the biochemical markers of bone formation tended to normalize shortly after alcohol withdrawal there were signs of a persistent high bone turnover after more than 5 years of abstinence. In a prospective population-based study in 242 men, we found that forearm BMD and skinfold thickness on the dorsum of the hand could be used in predicting future fracture. Testosterone and sex hormone binding globulin did not enhance the fracture prediction. Furthermore, we were unable to identify high consumers of alcohol by analyzing BMD and sex hormones.
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