Does Alcohol Cause Osteoporosis?

Osteoporosis is a growing concern in the U.S. Data suggests that about 1 in 4 adults older than 50 years have osteoporosis — the majority of which are women.

There are many factors that can increase the risk of osteoporosis. And for most of them, there’s strong evidence on what to do to limit your risk. But the evidence about how alcohol use affects your bones might be the most surprising. 

Here, we’ll summarize what is known about the effects of alcohol use on osteoporosis risk. And we’ll also address some cases when the data isn’t exactly clear — like when it comes to mild to moderate drinking.

Does alcohol cause osteoporosis?

Osteoporosis isn’t caused by any one factor in isolation. Instead, many different factors affect the risk of developing this condition. These factors include:

• Whether you had proper nutrition, especially during childhood and young adulthood

• Genetics or family history of osteoporosis

• Certain medical conditions, such as rheumatoid arthritis, diabetes, or premature menopause

• History of certain medical procedures, such as weight-loss surgery or organ transplantation

• Medications, such as selective serotonin reuptake inhibitors (SSRIs), corticosteroids, or aromatase inhibitors

Having a combination of multiple risk factors can change someone’s osteoporosis risk in different ways. And adding alcohol consumption into this complicates the picture even more.

Some research suggests that alcohol use early in life negatively affects peak bone mass. Peak bone mass is the maximum bone density we attain by early adulthood. And it’s an important part of our osteoporosis risk later in life. Frequent heavy drinking in early life might have an especially negative effect on our bone health later. In this research, frequent heavy drinking was defined as one to two episodes of binge drinking (4 or more drinks) a month, starting in high school. 

But the research isn’t always consistent. Another older study looked at average weekly alcohol consumption over 20 years. They found that consuming at least 7 oz of alcohol per week was associated with higher bone density in women after menopause. 

Most studies evaluate alcohol use in later adulthood. They mainly look at its association with osteoporosis or bone fractures. And the evidence there is mixed as well.

One review of multiple studies looked at the effect of different beverages on osteoporosis risk. Researchers found that people who drank alcohol had a higher chance of being diagnosed with osteoporosis. 

But another recent analysis of several studies found that consuming 1 to 3 drinks per day might actually be protective. Light drinking was associated with higher bone mineral density in the bones of the spine, leg, and hip. These are the bones that are especially prone to fracture in people with osteoporosis. So it’s possible that low levels of alcohol consumption might have a protective effect on fracture risk. 

There are few potential reasons why consuming alcohol might increase the risk of osteoporosis. Alcohol disrupts bone metabolism by:

• Impairing the function of bone-building cells called osteoblasts

• Directly causing bone cell loss

• Decreasing the absorption of nutrients essential for bone health, like calcium and vitamin D

• Affecting the hormones that help maintain healthy bones

We know that heavy drinking isn’t good for our bones. But experts are still unsure about the effects of mild to moderate alcohol use.

How much alcohol is too much for osteoporosis?

Experts aren’t certain exactly how much alcohol intake is too much for osteoporosis. But most studies are clear that heavy drinking increases the risk of osteoporosis and bone fractures. 

One recent analysis of multiple studies — including over 6 million participants — looked into how much alcohol affects your risk of a bone fracture. They found that the risk of fracturing any bone in the body increased with even mild alcohol consumption. For each additional alcoholic drink consumed per day, fracture risk increased by 6% over several years. 

But there’s an important caveat: This data included fractures both related and not related to osteoporosis — like skull fractures from a fall. And keep in mind that alcohol use is known to increase the risk of falls. 

So, then, researchers looked more closely at bone fractures associated with osteoporosis. These include hip, wrist, and vertebral fractures. And the data showed an interesting pattern. Consuming up to about 1.5 alcoholic drinks per day actually reduced the risk of osteoporotic bone fractures. This pattern was especially noticeable for hip fractures. But the risk of osteoporotic fractures then started increasing with heavier drinking. And fracture risk was significantly increased in those who consumed more than 3.5 drinks per day.

The evidence is clear that heavy drinking increases the risk of bone fractures related to osteoporosis. But more studies are needed to determine if 1 or 2 drinks per day might be safe — or even protective — in those concerned about osteoporotic fractures. So if you do choose to drink alcohol on occasion, it’s a good idea to limit consumption to no more than 2 drinks per day.

Can I drink alcohol if I already have osteoporosis?

Most studies look at how drinking affects the chance of being diagnosed with osteoporosis. But research on continued alcohol use by people who already have osteoporosis is limited.

In a recent study, researchers looked at people who drank alcohol. Then they compared those who had osteoporosis with those who didn’t. They found that people who drank alcohol and were diagnosed with osteoporosis had a higher risk of death from any cause. And their risk of dying specifically from heart disease was also higher. 

More research is needed looking at how alcohol use affects people who already have osteoporosis. But based on the current data, consistent heavy drinking increases the risk of osteoporotic bone fractures. And drinking may increase the risk of dying from heart disease in people with osteoporosis. So if you have osteoporosis, it’s still best to avoid regular alcohol use and limit intake to less than 2 drinks per day.

How can I prevent osteoporosis?

Osteoporosis prevention is a lifelong process that starts in childhood. But there are many steps you can take as an adult to help maintain your bone density. In addition to limiting alcohol use, these include:

• Eating foods high in calcium and vitamin D: Foods high in calcium include dairy products, tofu, kale, and broccoli. Dairy and nondairy milk is often also fortified with vitamin D.

• Moving your body: There are two types of exercise important for osteoporosis prevention: weight-bearing exercise (like walking or running) and muscle-strengthening exercises (like lifting weights or body-weight exercises like lunges).

• Avoiding smoking: Smoking is a known risk factor for osteoporosis.

It’s also important to get screened for osteoporosis — especially if you are at risk. The best age to do this depends on individual risk factors. But in general, screening is recommended for all women older than 65 years. A healthcare professional can help you decide the best time for you to get screened.

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Written by:

Joanna Jan, MD

Joanna Jan, MD, is board-certified in internal medicine and licensed to practice medicine in the state of Pennsylvania. In 2017, she received her board certification from the American Board of Internal Medicine.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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