Aim: High alcohol consumption is a clinical risk factor for fracture in the FRAX prediction tool. We aimed to determine the contribution of high alcohol consumption to increased fracture risk in men.
Methods: Subjects were men (aged 40-90yr) from the Geelong Osteoporosis Study. BMD was measured by DXA (Lunar), anthropometry was measured and health behaviours and fracture history were documented by questionnaire. Alcohol consumption was self-reported via the Cancer Council food frequency questionnaire. Drinkers were identified as consuming ≥3 units alcohol/day. FRAX (Aus) scores with BMD (FRAXBMD) and without BMD (FRAXnoBMD) were calculated. For drinkers, FRAX scores were calculated with and without a positive response to alcohol intake and differences were compared to determine the impact of alcohol on fracture risk. FRAX cut-points of ≥20% for major osteoporotic fractures (MOF) and ≥3% for hip fracture were adopted to identify those at high risk for fracture.
Results: Among 591 men, 122 (19%) were drinkers; prevalence of high alcohol consumption was 21.3% (40-49yr), 25.9% (50-59yr), 23.9% (60-69yr), 19.9% (70-79yr) and 13.0% (80-90yr). Among drinkers, alcohol use contributed to increases in fracture risk: for MOF, mean (±SD) FRAXBMD increased by 20.2% (±3.3) and FRAXnoBMD by 21.0% (±3.9); for hip fractures, FRAXBMD increased by 35.8% (±10.5) and FRAXnoBMD by 37.4% (±13.8). Only one drinker was at high risk for MOF and this number did not change when alcohol was considered in FRAXBMD. After considering high alcohol use, the number of men at high risk for hip fracture increased from 19 to 29 (FRAXBMD), representing a 1.7% increase in the number of men overall at high risk for hip fracture.
Conclusion: High alcohol consumption substantially contributed to high hip fracture risk. These data underscore the public health message to avoid high alcohol intake for bone health.