Alcohol intake and bone status in elderly Japanese men: Baseline data from the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Study
Research highlights
► Little is known about a relationship of alcohol with bone in elderly Japanese men. ► The FORMEN Study is a large-scale community-based study in Japan. ► Moderate alcohol intake was related to high bone mineral density in the FORMEN Study.
Introduction
Male osteoporosis was perceived as an unimportant problem until recently. However, men account for approximately one-third of the cases, and increasing longevity will lead to a future increase of male osteoporotic fractures [1]. Therefore, men with osteoporotic fractures will become a significant public health problem in aging societies.
Heavy alcohol intake by alcoholics is considered to be a risk factor for osteoporosis [1], [2], [3]. Heavy alcohol intake was also reported to be associated with an increased risk of falling in older adults [4]. Falls are a major cause of fractures [5], and are associated with hip fractures among elderly [6]. On the other hand, light alcohol intake has been reported to decrease the risk of falling [7], and moderate alcohol intake has been reported to be associated with an increase of bone mineral density (BMD) [8], [9]. In addition, a U-shaped relationship between alcohol consumption and hip fracture has been reported [10]. Recently, a systematic review combined with meta-analysis revealed that persons consuming from 0.5 to 1.0 drinks of alcohol per day (7 to 14 g/day) had a lower risk of hip fracture compared with abstainers [11].
While there is now strong evidence for an association between moderate alcohol consumption and bone health, the mechanisms involved are still unknown [9]. Both a direct effect of ethanol and also other factors, such as physical activity, could have a role. However, there have been few studies with sufficient adjustment for major potential confounders, including physical activity and socioeconomic status [11]. It has been reported that elderly men and women with light-to-moderate alcohol intake are more likely to remain mobile than nondrinkers [12], that moderate drinkers show better performance in physical function tests than teetotalers among older men [13], and that men with a light alcohol intake have less risk of falls [7]. Therefore, further studies with adjustment for all potential confounders are needed to interpret the influence of moderate alcohol intake on bone health.
The existence of racial differences in sensitivity to the effects of alcohol between Oriental and Caucasian populations has been well documented [14]. The higher sensitivity of Orientals is due to delayed oxidation of acetaldehyde by atypical aldehyde dehydrogenase [14]. The definition of “moderate” alcohol consumption for bone heath is not clear [9] and there may be racial differences of the association between alcohol intake and osteoporotic fracture or bone density. However, there is little information concerning male osteoporosis, especially among Asian men [15], [16], [17], [18], and there is no data concerning the relationship between alcohol and bone status, including bone turnover markers [19], from a large-scale community-based study of elderly Japanese men.
The Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Study is a large-scale community-based single-center prospective cohort study of elderly Japanese men [20]. Here, we report an association between alcohol consumption and BMD that was found in the baseline data from the FORMEN Study and persisted after adjustment for various potential confounders, including physical activity and educated level. We also provide information about the effects of alcohol on bone formation and resorption that was obtained by measuring biochemical markers of bone turnover.
Section snippets
Subjects
The FORMEN Study was performed as an ancillary study of the Fujiwara-kyo Study of elderly men and women in Nara Prefecture, Japan (the chief investigator of the Fujiwara-kyo study is Norio Kurumatani, MD, PhD, Professor and Chairman of the Department of Community Health and Epidemiology at Nara Medical University School of Medicine) [20]. Recruitment of subjects was done by the Fujiwara-kyo Study Administrative Center with cooperation of local residents' associations and elderly people's clubs
Results
Table 1 shows the characteristics of elderly Japanese men stratified by ethanol intake quartiles. We observed significant dose-dependent trends in ethanol intake quartiles for age, height, eating natto, smoking, milk intake, educational level and marital status.
Table 2 shows BMD stratified by the alcohol quartiles. There was an increase of the crude mean BMD for the total hip and femoral neck along with increasing alcohol intake. After adjustment for confounding factors, increased BMD in both
Discussion
Non-ethanol mechanisms such as healthy behavior may contribute to the association between moderate alcohol intake and bone health [9], [11]. However, according to a systematic review, few studies have sufficiently adjusted for major potential confounders, and no study evaluated markers of socioeconomic status [11]. The present data analysis from the FORMEN Study demonstrated that alcohol intake was related to high BMD after adjustment for various potential confounders, including educational
Acknowledgments
There is no conflict of interest that might bias our paper. This work was supported by Grants-in-Aid for Scientific Research (#20659103, #20590661, #20790451, and #21390210) from the Japanese Society for the Promotion of Science, a Grant-in-Aid for Study on Milk Nutrition (2008) from the Japan Dairy Association, a Grant (2007) from the Foundation for Total Health Promotion, a St. Luke's Life Science Institute Grant-in-Aid for Epidemiological Research (2008), and a Grant (2008) from the Physical
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