ALCOHOL-INDUCED BONE-DISEASE IN THE ABSENCE OF SEVERE CHRONIC LIVER-DAMAGE

To define and identify metabolic bone disease and mineral alterations induced by chronic heavy alcoholism in patients without severe liver d amage, we studied a prospective series of unselected patients admitted to a 300-bed general hospital in Barcelona (Spain). A total of 26 chr onic heavy drinkers of more than 150 g/day for at least 3 years were i ncluded. A general analytic and hormonal study, including liver biopsy in cases with any abnormality in liver function tests, and plasma and urine biochemistry with calcium regulating hormones and osteocalcin l evels were determined. A transiliac bone biopsy after double-tetracycl ine labeling, with histomorphometric study of undecalcified bone, was performed. Statistical analysis was adjusted by age and sex by means o f logistic regression. A total of 26 (20 men and 6 women) chronic alco hol abusers were studied. After adjustment for age and sex, alcoholic patients showed slight but significantly increased concentrations of p lasma calcium (9.56 +/- 0.56; OR = 17.93; 95% CI3.17-101.48) and decre ased cPTH(0.36 +/- 0.11; OR = 0.097; 95% CI0.018-0.528) compared with controls. Osteocalcin values were low (1.49 +/- 0.89, normal range 1.8 -6.6). There was a significant decrease in bone volume, BV/TV (12.56 /- 5.29; OR = 0.06; 95% CI 0.01-0.34), with increased resorption surfa ces, ES/BS (4.28 +/- 2.43; OR = 9.86; 95% CI2.16-45.07), and increased osteoclast number, N.Oc/TA (0.21 +/- 0.37; OR = 6.41; 95% CI 1.27-32. 25). Dynamic parameters were abnormal (Fisher's exact test), as follow s: decreased BPR/BS (0.023 +/- 0.028 versus 0.049 +/- 0.020; p = 0.013 ), MAR (0.309 +/- 0.269 versus 0.771 +/- 0.529;p = 0.029), MS/BS (3.74 3 +/- 4.433 versus 5.890 +/- 2.882;p = 0.008, and OMR (2.402 +/- 2.833 versus 3.057 +/- 0.083; p = 0.011) and increased MLT (175.80 +/- 405. 49 versus 34.53 +/- 8.117; p = 0.008). We conclude that chronic alcoho l consumption induces osteopenia with low turnover and increased osteo clast number and resorption surfaces. The increase in plasma calcium l evels and decreased PTH suggests a primary effect of alcohol on bone, resulting in bone loss and calcium infusion from bone into plasma. The se effects were observed in the absence of significant liver damage.