The effect of moderate alcohol consumption on bone mineral density: a study of female twins

Approximation of bone mineral density and subcutaneous adiposity using T1-weighted images of the human head

Bones and brain are intricately connected and scientific interest in their interaction is growing. This has become particularly evident in the framework of clinical applications for various medical conditions, such as obesity and osteoporosis. The adverse effects of obesity on brain health have long been recognised, but few brain imaging studies provide sophisticated body composition measures. Here we propose to extract the following bone- and adiposity-related measures from T1-weighted MR images of the head: an approximation of skull bone mineral density (BMD), skull bone thickness, and two approximations of subcutaneous fat (i.e., the intensity and thickness of soft non-brain head tissue). The measures pertaining to skull BMD, skull bone thickness, and intensi-ty-based adiposity proxy proved to be reliable ( r =.93/.83/.74, p <.001) and valid, with high correlations to DXA-de-rived head BMD values (rho=.70, p <.001) and MRI-derived abdominal subcutaneous adipose volume (rho=.62, p <.001). Thickness-based adiposity proxy had only a low retest reliability ( r =.58, p <.001).The outcomes of this study constitute an important step towards extracting relevant non-brain features from available brain scans.

Exposure to Multiple Air Pollutants and the Risk of Fractures: A Large Prospective Population-Based Study

Atmospheric chemistry studies suggest air pollution impedes ultraviolet B photons and thus reduces cutaneous vitamin D3 synthesis. Biological evidence shows that inhaled pollutants disrupt circulating 25-hydroxyvitamin D (25[OH]D) metabolism and ultimately impact bone health. The hypothesis is that higher air pollution concentrations are associated with a higher risk of fractures, mediated by lower circulating 25(OH)D. The study included participants of the UK Biobank who were free of fracture history at enrollment (2006 to 2010) and analyzed their environmental exposure data (2007 to 2010). Air pollution measurements included the annual averages of air particulate matter (PM2.5 , PM2.5-10 , and PM10 ), nitrogen oxides (NO2 and NOx ), and a composite air pollution score. Multivariable Cox proportional hazard models were used to assess the associations of the individual pollutants and the score with fracture risks. Mediation analyses were conducted to assess the underlying role of serum 25(OH)D in such associations. Among 446,395 participants with a median of 8-year follow-up, 12,288 incident fractures were documented. Participants living in places with the highest quintile of air pollution score had a 15.3% increased risk of fractures (hazard ratio [95%CI]: 1.15[1.09,1.22]) compared to those in the lowest, and 5.49% of this association was mediated through serum 25(OH)D (pmediation  < 0.05). Pollutant-specific hazard of top-to-bottom quintiles was 16% for PM2.5 , 4% for PM2.5-10 , 5% for PM10 , 20% for NO2 , and 17% for NOx , with a 4% to 6% mediation effect of serum 25(OH)D concentrations. The associations of the air pollution score with fracture risks were weaker among female participants, those who drank less alcohol, and consumed more fresh fruit than their counterparts (pinteraction  < 0.05). © 2023 American Society for Bone and Mineral Research (ASBMR).

Association of alcohol and bone mineral density dependent on type of alcohol consumed

INTRODUCTION

Osteoporosis prevalence will increase in coming decades, with significant financial and economic implications. Whilst alcohol excess has significant detrimental impacts on bone mineral density (BMD), knowledge of low-volume consumption is inconsistent. Type of alcohol may mediate impact on BMD and warrants further investigation.

MATERIALS AND METHODS

Participants were drawn from the Florey Adelaide Male Aging Study, a cohort of community dwelling men from Adelaide, Australia (n = 1195). The final cohort (n = 693) provided information regarding alcohol consumption and undertook BMD scan at wave one (2002-2005) and wave two (2007-2010). Cross-sectional and longitudinal multivariable regression was performed for whole-body and spine BMD. To assess change in exposure over time, change in BMD was compared to change in covariates between waves.

RESULTS

Cross-sectionally, whole-body BMD was positively associated with obesity (p < 0.001), exercise (p = 0.009), prior smoking (p = 0.001), oestrogen concentration (p = 0.001), rheumatoid arthritis (p = 0.013) and grip strength (p < 0.001). No association was identified with volume of differing types of alcohol consumed. Spinal BMD was inversely associated with low-strength beer consumption (p = 0.003). The volume of alcohol consumed at Wave 1 did not predict change in whole-body or spinal BMD; however, increases in full-strength beer consumption between waves were associated with reduced spinal BMD (p = 0.031).

CONCLUSION

When consumed at quantities in the usual social range, alcohol was not associated with whole-body BMD. However, low-strength beer consumption was inversely related to spinal BMD.

Applications of Artificial Intelligence Methods for the Prediction of Osteoporotic Fractures

Background: Osteoporosis is a socio-economic problem of modern aging societies. Bone fractures and the related treatments generate the highest costs. The occurrence of osteoporotic fractures is a cause of chronic disability, many complications, reduced quality of life, and often premature death. Aim of the study: The aim of the study was to determine which of the patient's potential risk factors pertaining to various diseases and lifestyle have an essential impact on the occurrence of low-energy fractures and the hierarchy of these factors. Methods: The study was retrospective. The documentation of 222 patients (206 women and 16 men) from an osteoporosis treatment clinic in Łódź, Poland was analyzed. Each patient was described by a vector consisting of 27 features, where each feature was a different risk factor. Using artificial neural networks, an attempt was made to create a model that, based on the available data, would be able to predict whether the patient would be exposed to low-energy fractures. We developed a neural network model that achieved the best result for the testing data. In addition, we used other methods to solve the classification problem, i.e., correctly dividing patients into two groups: those with fractures and those without fractures. These methods were logistic regression, k-nearest neighbors and SVM. Results: The obtained results gave us the opportunity to assess the effectiveness of various methods and the importance of the features describing patients. Using logistic regression and the recursive elimination of features, a ranking of risk factors was obtained in which the most important were age, chronic kidney disease, neck T-score, and serum phosphate level. Then, we repeated the learning procedure of the neural network considering only these four most important features. The average mean squared error on the test set was about 27% for the best variant of the model. Conclusions: The comparison of the rankings with different numbers of patients shows that the applied method is very sensitive to changes in the considered data (adding new patients significantly changes the result). Further cohort studies with more patients and more advanced methods of machine learning may be needed to identify other significant risk factors and to develop a reliable fracture risk system. The obtained results may contribute to the improved identification patients at risk of low-energy fractures and early implementation of comprehensive treatment.

Bone Health in Adults With Prader-Willi Syndrome: Clinical Recommendations Based on a Multicenter Cohort Study

CONTEXT

Prader-Willi syndrome (PWS) is a rare complex genetic syndrome, characterized by delayed psychomotor development, hypotonia, and hyperphagia. Hormone deficiencies such as hypogonadism, hypothyroidism, and growth hormone deficiency are common. The combination of hypotonia, low physical activity, and hypogonadism might lead to a decrease in bone mass and increase in fracture risk. Moreover, one would expect an increased risk of scoliosis due to hypotonia and low physical activity.

OBJECTIVE

To study the prevalence and risk factors for skeletal problems (reduced bone mineral density, fractures, and scoliosis) in adults with PWS.

METHODS

We retrospectively collected patient characteristics, medical history, medication, biochemical measurements, dual-energy X-ray absorptiometry scans, and spinal X-rays and reviewed the current literature.

RESULTS

We included 354 adults with PWS (median age 31 years; 43% males), of whom 51 (14%) had osteoporosis (T-score below -2.5) and 143 (54%) had osteopenia (T-score -1 to -2.5). The most prevalent modifiable risk factors for osteoporosis were hypogonadism, insufficient dairy intake, sedentary lifestyle, and corticosteroid use. Male sex was associated with osteoporosis (P = .005). Growth hormone treatment was not associated with osteoporosis. A history of vertebral fractures was present in 10 (3%) and nonvertebral fractures in 59 (17%). Scoliosis was present in 263 (80%), but no modifiable risk factors were identified.

CONCLUSION

Besides scoliosis, osteoporosis is common in adults with PWS. Based on the literature and the risk factors for osteoporosis found in our cohort, we provide practical clinical recommendations to avoid skeletal complications in these vulnerable patients.

Effect of ethanol consumption during pregnancy and lactation on bone histomorphometry and in vitro osteogenic differentiation of bone marrow mesenchymal stem cells in maternal rats

This study aimed to evaluate the effect of maternal ethanol consumption during gestation and lactation on bone mass and osteogenic differentiation of mesenchymal stem cells of the bone marrow (BMMSCs) in rats. Thirteen adult Wistar rats were used. The rats were mated, and after confirmation of gestation, (day 0) they were distributed in two groups: the control group and the ethanol-treated group. From the ninth day of gestation, the rats of the ethanol and control groups were administered 40% alcoholic solution (4 g ethanol/kg) and distilled water, respectively, daily via gavage until the thirtieth day of lactation. The BMMSCs were extracted from the right femurs and tibiae and cultured using an osteogenic medium for 7, 14, and 21 days. The conversion of MTT to formazan crystals, alkaline phosphatase activity, and percentages of cells per field were analyzed. The number of mineralized nodules per field was examined, and quantification of the gene transcripts for osteopontin, osteocalcin, and BMP-2 was evaluated on day 21 by real-time RT-PCR. Morphometric evaluations of the percentage of trabecular bone and cortical thickness in the left femur and tibia were performed. The means were compared by the Student's t-test, and the differences were considered significant if p < 0.05. The BMMSCs of the rats that consumed ethanol during gestation and lactation, when subjected to osteogenic differentiation in vitro, demonstrated higher conversion of MTT to formazan, higher alkaline phosphatase activity, a higher percentage of cells per field, higher expression of BMP-2, and higher synthesis of mineralized nodules when compared to those of control rat cells. However, there was no significant difference in the percentage of trabecular bone or cortical thickness between both groups. Hence, the consumption of ethanol during pregnancy and lactation did not alter the trabecular and cortical bone tissues of the femur and tibia compared with that of pregnant and lactating control rats that did not consume alcohol, despite BMMSCs showing higher osteogenic differentiation under in vitro conditions.

Alcoholism and Osteoimmunology

BACKGROUND

Chronic consumption of alcohol has an adverse effect on the skeletal system, which may lead to osteoporosis, delayed fracture healing and osteonecrosis of the femoral head. Currently, the treatment is limited, therefore, there is an urgent need to determine the underline mechanism and develop a new treatment. It is well-known that normal bone remodeling relies on the balance between osteoclast-mediated bone resorption and - mediated bone formation. Various factors can destroy the balance, including the dysfunction of the immune system. In this review, we summarized the relevant research in the alcoholic osteopenia with a focus on the abnormal osteoimmunology signals. We provided a new theoretical basis for the prevention and treatment of the alcoholic bone.

METHODS

We searched PubMed for publications from 1 January 1980 to 1 February 2020 to identify relevant and recent literature, summarizing evaluation and the prospect of alcoholic osteopenia. Detailed search terms were 'alcohol', 'alcoholic osteoporosis', 'alcoholic osteopenia' 'immune', 'osteoimmunology', 'bone remodeling', 'osteoporosis treatment' and 'osteoporosis therapy'.

RESULTS

A total of 135 papers are included in the review. About 60 papers described the mechanisms of alcohol involved in bone remodeling. Some papers were focused on the pathogenesis of alcohol on bone through osteoimmune mechanisms.

CONCLUSION

There is a complex network of signals between alcohol and bone remodeling and intercellular communication of osteoimmune may be a potential mechanism for alcoholic bone. Studying the osteoimmune mechanism is critical for drug development specific to the alcoholic bone disorder.

Factors Associated with Low Bone Density in Opioid Substitution Therapy Patients: A Systematic Review

Background: Long-term opioid therapy is a risk factor for low bone mineral density (BMD). However, other factors may also contribute to low BMD. Several studies have examined the variables that might contribute to low BMD in patients receiving opioid replacement therapy (OST). However, to our knowledge, there was no systemic review conducted to address this particular issue. Thus, we reviewed the articles on the factors associated with low BMD in the population of opioid use disorder receiving substitution therapy. Methods: The articles that examined correlates or risk factors of low BMD in OST population were retrieved from OVID, SCOPUS, and PUBMED from inception until July 2020 by two independent investigators. Results: A total of 429 articles from three databases were retrieved initially. After screening based on eligibility criteria, five articles were included in the final analysis. The risk factors or correlates found to be significantly associated with low BMD in the OST population include male gender, low body mass index, low testosterone level, methadone or heroin use, and longer duration of heavy alcohol use. The review limitations include small sample sizes and inconsistent definition of variables. Conclusion: OST patients should be screened for BMD and its associated factors. Guidelines and training of practitioners involving in the OST service should be provided to increase the detection of low BMD in the OST population.

Determinants of Bone Health Status in a Multi-Ethnic Population in Klang Valley, Malaysia

Background and objectives: Studies on osteoporosis risk factors are limited in Malaysia, so this study assesses the factors associated with bone health assessed using dual-energy X-ray absorptiometry (DXA) among Malaysians aged ≥40 years. Subjects and Methods: Data on demography, medical history, dietary and lifestyle practices of 786 Malaysians (51.4% women) aged ≥40 years recruited in Klang Valley were obtained. Their body composition and bone health were determined using DXA. The association between risk factors and bone health status was assessed using binary logistic regression. Results: The prevalence of suboptimal bone health and osteoporosis was higher in women (59.4% and 16.1%) than men (40.8% and 8.4%). Overall, the predictors of suboptimal bone health and osteoporosis among the subjects were increased age and higher fat mass. Lower monthly income was positively associated with osteoporosis. Being menopausal was a risk factor for both suboptimal bone health and osteoporosis in women. Women with no formal education were more likely to get osteoporosis. Being a smoker and Chinese were positively related to suboptimal bone health among men. Meanwhile, predictors of osteoporosis among men were regular alcohol and dairy product consumption, higher fat mass and having a tertiary education. Conclusions: This study calls for immediate and effective interventions for middle-aged and elderly populations with risk factors to halt the progression of bone loss.

Effects of different alcohol concentrations on the development of apical periodontitis in rats

AIM

To investigate the effect of different alcohol concentrations on the development of apical periodontitis (AP) in rats.

METHODS

Forty Wistar rats were arranged into five groups: (C) - control rats receiving sterile water as the only liquid; (G5) - animals receiving an alcohol solution at 5%, (G10) - alcohol solution at 10%, (G15) - alcohol solution at 15%, and (G20) - alcohol solution at 20%. The alcoholic solution or water was given to the groups as the sole source of hydration throughout the 30 days of the experiment. AP was induced in the mandibular molars on the first day. In the end, the animals were euthanized for histopathological and IL-1b, RANKL, OPG, and TRAP analyses. The Kruskal-Wallis test was used for nonparametric data, and ANOVA followed by the Tukey test were performed for parametric data, p < 0.05.

RESULTS

G15 and G20 had a greater chronic inflammatory infiltrate (Score 3) and AP size bigger (1.59 ± 0.41 and 1.83 ± 0.38, respectively) than the C, G5 and G10 (p < 0.05). No significant difference was found in the IL-1b analyses. The G15 and G20 showed the highest immunolabeling pattern for RANKL and the lowest for OPG. The G20 had greater TRAP cells per mm (4.70 ± 0.99) compared to the C, G5, and G10 (p < 0.05). Furthermore, G15 presented 3.92 ± 0.64 TRAP cells/mm, higher than C (p < 0.05).

CONCLUSIONS

G5 and G10 did not exert a protective or aggravating effect on the AP development. However, G15 and G20 had a significant effect on the AP severity, exacerbating the inflammation and osteoclast markers.

Is There Causal Relationship of Smoking and Alcohol Consumption with Bone Mineral Density? A Mendelian Randomization Study

Observational studies examining associations of smoking and alcohol consumption with bone mineral density (BMD) have generated inconsistent results and suffer from several methodological limitations. We aim to evaluate whether there are causal associations between smoking, alcohol consumption, and BMD using a Mendelian randomization (MR) design. Genetic variants associated with smoking status (n = 142), no. of cigarettes smoked per day (CPD) (n = 3), smoking initiation (n = 1), and alcohol consumption (n = 6) identified in published genome-wide association studies (GWAS) were used as instruments. Summary statistics data of 32735, 28498, 8143, and 445921 European subjects included in The GEnetic Factors for Osteoporosis Consortium or UK Biobank were used to generate associations of genetically predicted smoking or alcohol consumption with femoral neck (FN-BMD), lumbar spine (LS-BMD), forearm (FA-BMD), and heel BMD, respectively, by using the inverse-variance weighted method. The BMD was measured using either ultrasound (for heel) or Dual-energy X-ray Absorptiometry (for others). In our analyses, smoking status tended to be negatively associated with several types of BMD (heel BMD: β = - 0.053, p = 0.003; FN-BMD: β = - 0.139, p = 0.053; FA-BMD: β = - 0.264, p = 0.077), although the association with LS-BMD was null. Smoking initiation was significantly inversely associated with heel BMD (β = - 0.201, p = 3.60 × 10^-8). CPD was associated with a lower FN-BMD (β = - 0.014, p = 0.047) only. There was no clear association of genetically predicted alcohol consumption with BMD. Our study provided some evidence of a potential association between genetically predicted smoking and lower BMD, especially for heel BMD, but not for alcohol consumption. Considering the inconsistent findings with the different types of BMD and limitations of the current work, further studies are needed to better characterize the exact relationship between smoking, alcohol consumption, and BMD.

Mediterranean diet, diet quality, and bone mineral content in adolescents: the HELENA study

Dietary scores, rather than individual nutrients, allow exploring associations between overall diet and bone health. The aim of the present study was to assess the associations between the Mediterranean Diet Score for Adolescents (MDS-A) and the Diet Quality Index for Adolescents (DQI-A) and bone mineral content (BMC) among Spanish adolescents. Our results do not support an association between dietary scores or indices and BMC in adolescents.

INTRODUCTION

To assess the associations between the MDS-A and a DQI-A with the BMC measured with dual-energy X-ray absorptiometry.

METHODS

The MDS-A and the DQI-A were calculated in 179 Spanish adolescents, based on two 24-h dietary recalls from the HELENA cross-sectional study. The associations between the diet scores and the BMC outcomes [total body less head (TBLH), femoral neck (FN), lumbar spine (LS), and hip] were analyzed using logistic regression models adjusting for several confounders.

RESULTS

Four hundred ninety-two models were included and only fruits and nuts and cereal and roots were found to provide significant ORs with regard to BMC. The risk of having low BMC reduced by 32% (OR 0.684; CI 0.473-0.988) for FN when following the ideal MDS-A, but this association lost significance when adjusting for lean mass and physical activity. For every 1-point increase in the cereal and root and the fruit and nut components, the risk of having low FN diminished by 56% (OR 0.442; CI 0.216-0.901) and by 67% (OR 0.332; CI 0.146-0.755), respectively.

CONCLUSION

An overall dietary score or index is not associated with BMC in our adolescent Spanish sample.

Socioeconomic factors and individual lifestyles influencing the incidence of patella fractures: a national population-based survey in China

BACKGROUND

We aimed to do a national survey on the population-based incidence of patella fractures and related risk factors fracture in China.

METHODS

All the data on patella fractures were available from the China National Fracture Survey (CNFS) between January and May in 2015. And in the CNFS, all eligible household members were selected from 24 urban cities and 24 rural counties of eight provinces of China, with stratified random sampling and the probability proportional to size method used. Questionnaire was sent to every participant for data collection and quality control was accomplished by our research team members.

RESULTS

A total of 512,187 valid questionnaires were collected, and relevant data were abstracted. There were a total of 69 patients with 69 patella fractures that occurred in 2014, indicating that the incidence was 13.5 (95% CI, 10.3-16.7))/100,000 person-years. Slip, trip, or fall from standing height was the most common cause, leading to 69.6% (48/69) of patella factures, followed by traffic accidents (18.8%, 13/69). Home and road were the first two most common places, where 86.9% of the overall injuries occurred. Age of 45-64 and 65-74 years, alcohol consumption and previous history of fractures were identified as independent risk factors for patella fracture.

CONCLUSIONS

Specific public health policies focusing on decreasing alcohol consumption should be implemented. Individuals aged 45-64 and 65-74 should pay more attention to bone mass density and prevention of falls, especially those with previous history of fracture.

Cellular and molecular mechanisms of alcohol-induced osteopenia

Alcoholic beverages are widely consumed, resulting in a staggering economic cost in different social and cultural settings. Types of alcohol consumption vary from light occasional to heavy, binge drinking, and chronic alcohol abuse at all ages. In general, heavy alcohol consumption is widely recognized as a major epidemiological risk factor for chronic diseases and is detrimental to many organs and tissues, including bones. Indeed, recent findings demonstrate that alcohol has a dose-dependent toxic effect in promoting imbalanced bone remodeling. This imbalance eventually results in osteopenia, an established risk factor for osteoporosis. Decreased bone mass and strength are major hallmarks of osteopenia, which is predominantly attributed not only to inhibition of bone synthesis but also to increased bone resorption through direct and indirect pathways. In this review, we present knowledge to elucidate the epidemiology, potential pathogenesis, and major molecular mechanisms and cellular effects that underlie alcoholism-induced bone loss in osteopenia. Novel therapeutic targets for correcting alcohol-induced osteopenia are also reviewed, such as modulation of proinflammatory cytokines and Wnt and mTOR signaling and the application of new drugs.

Gender Differences and Socioeconomic Factors Related to Osteoporosis: A Cross-Sectional Analysis of Nationally Representative Data

BACKGROUND

Osteoporosis has been considered a disease that primarily affects women, but recently male osteoporosis is also attracting attention. This study aims to comparatively analyze socioeconomic and other factors that are related to the prevalence of osteoporosis in both men and women.

MATERIALS AND METHODS

This study used data from the Korean Community Health Survey conducted in 2013. To determine factors related to osteoporosis prevalence, researchers applied a binary logistic regression model, first for all research participants, then separately for male and female participants.

RESULTS

Women were more likely than men to have osteoporosis (odds ratio 12.33, 95% confidence interval 11.55-13.17). Factors related to osteoporosis prevalence included age, education level, region, economic activity, alcohol consumption, salt intake, depression, and body mass index in both genders. Low education and income levels were more highly associated with osteoporosis prevalence in women than in men.

CONCLUSIONS

Most of the factors were not gender specific, but some socioeconomic determinants varied by gender. Future studies that will focus on the effects of socioeconomic factors on osteoporosis, as well as gender-related differences in prevention and control of osteoporosis, are needed.

Does low alcohol use increase the risk of sickness absence? A discordant twin study

Background

Results from observational studies suggest that people who drink little or no alcohol are less healthy than medium drinkers. This has been demonstrated for many different measures of health, including sick leave. However, whether these associations are causal or due to confounding remains to be clarified. The aim of this study was to use a discordant twin design to determine whether the increased level of sick leave associated with a low level of alcohol consumption, as compared to those with a medium level of consumption, reflects a causal mechanism or is due to genetic or environmental confounding.

Methods

Six thousand seven hundred thirty-four young adult twins from the Norwegian Institute of Public Health’s twin panel were in 1998 assessed for frequency of alcohol use and binge drinking. Data were linked to the Norwegian National Insurance Administration’s recordings of sick leave over a 10 year period. The associations between alcohol consumption and sick leave were first estimated in the total study population, and then within di- and monozygotic twin pairs discordant for alcohol use.

Results

Compared to medium consumption, both low and high alcohol consumption was associated with increased risk of sick leave. When low level drinkers were compared to medium level drinkers in a discordant twin design, the results were consistent with the association being due to genetic confounding rather than a causal effect.

Conclusions

The increased level of sick leave observed with low level drinkers seems to be mainly explained by confounding from genetic factors. In all observational studies of the relationship between alcohol consumption and health, one should be aware that important genetic confounders are likely to influence the results.

Successful treatment of refractory neuroSjogren with Rituximab

We report a 47-year-old female with Sjogren's syndrome (SS) and severe weakness in her lower extremities refractory to cyclophosphamide therapy, who was treated with the monoclonal anti CD-20 antibody rituximab at a weekly dose of 375 mg/m2 for four consecutive weeks. Patient responded within few days of the first dose and her motor power in the lower extremities started to improve gradually along with progressive resolution of the paresthesias and dysesthesias. The improvement was sustained and progressive and eight months after the last dose, she was able to walk for 60 meters without aid or rest. Rituximab may be considered as an effective and promising novel therapy in SS patients with neurological involvement. Lupus (2007) 16, 521—523.

Bone health and vitamin D status in alcoholic liver disease

Alcohol consumption is harmful to many organs and tissues, including bones, and it leads to osteoporosis. Hepatic osteodystrophy is abnormal bone metabolism that has been defined in patients with chronic liver disease (CLD), including osteopenia, osteoporosis, and osteomalacia. Decreased bone density in patients with CLD results from decreased bone formation or increased bone resorption. The prevalence of osteopenia in alcoholic liver disease (ALD) patients is between 34 % and 48 %, and the prevalence of osteoporosis is between 11 % and 36 %. Cirrhosis is also a risk factor for osteoporosis. The liver has an important role in vitamin D metabolism. Ninety percent of patients with alcoholic liver cirrhosis have vitamin D inadequacy (<80 nmol/L). The lowest serum vitamin D levels were observed in patients with Child-Pugh class C. Bone densitometry is used for the definitive diagnosis of osteoporosis in ALD. There are no specific controlled clinical studies on the treatment of osteoporosis in patients with ALD. Alcohol cessation and abstinence are principal for the prevention and treatment of osteoporosis in ALD patients, and the progression of osteopenia can be stopped in this way. Calcium and vitamin D supplementation is recommended, and associated nutritional deficiencies should also be corrected. The treatment recommendations of osteoporosis in CLD tend to be extended to ALD. Bisphosphonates have been proven to be effective in increasing bone mineral density (BMD) in chronic cholestatic disease and post-transplant patients, and they can be used in ALD patients. Randomized studies assessing the management of CLD-associated osteoporosis and the development of new drugs for osteoporosis may change the future. Here, we will discuss bone quality, vitamin D status, mechanism of bone effects, and diagnosis and treatment of osteoporosis in ALD.

Alcohol: A Simple Nutrient with Complex Actions on Bone in the Adult Skeleton

BACKGROUND

Alcohol is an important nonessential component of diet, but the overall impact of drinking on bone health, especially at moderate levels, is not well understood. Bone health is important because fractures greatly reduce quality of life and are a major cause of morbidity and mortality in the elderly. Regular alcohol consumption is most common following skeletal maturity, emphasizing the importance of understanding the skeletal consequences of drinking in adults.

METHODS

This review focuses on describing the complex effects of alcohol on the adult skeleton. Studies assessing the effects of alcohol on bone in adult humans as well as skeletally mature animal models published since the year 2000 are emphasized.

RESULTS

Light to moderate alcohol consumption is generally reported to be beneficial, resulting in higher bone mineral density (BMD) and reduced age-related bone loss, whereas heavy alcohol consumption is generally associated with decreased BMD, impaired bone quality, and increased fracture risk. Bone remodeling is the principal mechanism for maintaining a healthy skeleton in adults and dysfunction in bone remodeling can lead to bone loss and/or decreased bone quality. Light to moderate alcohol may exert beneficial effects in older individuals by slowing the rate of bone remodeling, but the impact of light to moderate alcohol on bone remodeling in younger individuals is less certain. The specific effects of alcohol on bone remodeling in heavy drinkers are even less certain because the effects are often obscured by unhealthy lifestyle choices, alcohol-associated disease, and altered endocrine signaling.

CONCLUSIONS

Although there have been advances in understanding the complex actions of alcohol on bone, much remains to be determined. Limited evidence implicates age, skeletal site evaluated, duration, and pattern of drinking as important variables. Few studies systematically evaluating the impact of these factors have been conducted and should be made a priority for future research. In addition, studies performed in skeletally mature animals have potential to reveal mechanistic insights into the precise actions of alcohol and associated comorbidity factors on bone remodeling.

A Review on the Sex Differences in Organ and System Pathology with Alcohol Drinking

Hazardous consequences of alcohol consumption adversely influence overall health, specifically physical and mental health. Differences in alcohol consumption and manifestations in pathology have been observed between males and females, however research on understanding these differences is limited. Negative consequences of alcohol consumption have now been studied including sex as a significant factor. Some studies have shown differences in the severity of consequences of alcohol consumption between the sexes, both in the mental consequences and changes/ injury in various organ systems. Over time, reports in females on both the dynamics of drinking and on the hazardous consequences of alcohol consumption have grown, primarily because of more awareness, better observation, and the inclusion of sex as a factor in scientific investigations. This paper reviews role of sex differences in pathophysiological and behavioral consequences of alcohol drinking.

Association between alcohol consumption and Korean young women's bone health: a cross sectional study from the 2008 to 2011 Korea National Health and Nutrition Examination Survey

OBJECTIVES

To assess the association between alcohol consumption and healthy Korean young women bone by Alcohol Use Disorders Identification Test (AUDIT) scores and drinking consumption; frequency and amount.

DESIGN

Cross-sectional study composed of three parts: health interview, health examination, nutrition survey.

SETTING

2008-2011 Korea National Health and Nutrition Examination Survey.

PARTICIPANTS

Of the 21,303 participants whose bone mineral density (BMD) was assessed, 1176 healthy women aged 19-30 years were selected.

PRIMARY AND SECONDARY OUTCOME MEASURES

Mean BMD T-scores of the total femur (TF), femur neck (FN) and lumbar spine (LB) by drinking consumption and AUDIT scores, and the odds of having a low BMD (T-score <-1) at the sites by AUDIT scores.

RESULTS

After adjustment, lower BMD was found at three sites in those who drank more and had higher AUDIT scores. These associations were significant by AUDIT scores at TF (p=0.002) and FN (p=0.004) and by drinking frequency and amount at FN (p=0.029 and 0.039, respectively). The adjusted OR of having low BMD increased significantly, particularly at FN, in those who had higher AUDIT scores such as 16-17 harmful drinking (OR 4.31; 95% CI 1.16 to 16.06) and 20-40 alcohol dependence (OR 5.99; 95% CI 1.69 to 21.21), compared with young women who scored 0-7 low-risk drinking or abstinence. No beneficial effect of moderate drinking was observed at any of the sites and the association between alcohol consumption and bone health was most evident at FN.

CONCLUSIONS

It is crucial to promote the awareness of alcohol harm on Korean young women's bone health. At the same time, since alcohol's effect on the bone is complex with cumulative effects of various factors over the years and there is an absence of studies with young women in their twenties, more studies, in particular for FN, are needed with more precise and appropriate design to confirm our findings.

Osteoporosis and bone fractures in alcoholic liver disease: A meta-analysis

AIM: To evaluate the association between alcoholic liver disease (ALD) and bone fractures or osteoporosis.

METHODS: Non-randomized studies were identified from databases (PubMed, EMBASE, and the Cochrane Library). The search was conducted using Boolean operators and keywords, which included “alcoholic liver diseases”, “osteoporosis”, or “bone fractures”. The prevalence of any fractures or osteoporosis, and bone mineral density (BMD) were extracted and analyzed using risk ratios and standardized mean difference (SMD). A random effects model was applied.

RESULTS: In total, 15 studies were identified and analyzed. Overall, ALD demonstrated a RR of 1.944 (95%CI: 1.354-2.791) for the development of bone fractures. However, ALD showed a RR of 0.849 (95%CI: 0.523-1.380) for the development of osteoporosis. BMD was not significantly different between the ALD and control groups, although there was a trend toward lower BMD in patients with ALD (SMD in femur-BMD: -0.172, 95%CI: -0.453-0.110; SMD in spine-BMD: -0.169, 95%CI: -0.476-0.138). Sensitivity analyses showed consistent results.

CONCLUSION: Current publications indicate significant associations between bone fractures and ALD, independent of BMD or the presence of osteoporosis.

Lifestyle and osteoporosis

Osteoporosis is associated with a number of lifestyle factors, including nutritional factors such as intake of calcium, protein, dairy food, fruits and vegetables and vitamin D status, and behavioural factors such as physical activity, smoking and alcohol consumption. Ensuring adequate calcium intake and vitamin D status and having regular weight-bearing physical activity throughout life are important for bone health and the prevention of osteoporosis and related fractures. Studies have shown that smoking and excessive alcohol intake have adverse effects on bone health and increase the risk of fracture. There is evidence suggesting that adequate protein intake and higher intake of fruits and vegetables are beneficial to bone health.

Epigenetics of discordant monozygotic twins: implications for disease

Monozygotic (MZ) twins share nearly all of their genetic variants and many similar environments before and after birth. However, they can also show phenotypic discordance for a wide range of traits. Differences at the epigenetic level may account for such discordances. It is well established that epigenetic states can contribute to phenotypic variation, including disease. Epigenetic states are dynamic and potentially reversible marks involved in gene regulation, which can be influenced by genetics, environment, and stochastic events. Here, we review advances in epigenetic studies of discordant MZ twins, focusing on disease. The study of epigenetics and disease using discordant MZ twins offers the opportunity to control for many potential confounders encountered in general population studies, such as differences in genetic background, early-life environmental exposure, age, gender, and cohort effects. Recently, analysis of disease-discordant MZ twins has been successfully used to study epigenetic mechanisms in aging, cancer, autoimmune disease, psychiatric, neurological, and multiple other traits. Epigenetic aberrations have been found in a range of phenotypes, and challenges have been identified, including sampling time, tissue specificity, validation, and replication. The results have relevance for personalized medicine approaches, including the identification of prognostic, diagnostic, and therapeutic targets. The findings also help to identify epigenetic markers of environmental risk and molecular mechanisms involved in disease and disease progression, which have implications both for understanding disease and for future medical research.

Alcohol and bone

Alcohol is widely consumed across the world in different cultural and social settings. Types of alcohol consumption differ between (a) light, only occasional consumption, (b) heavy chronic alcohol consumption, and (c) binge drinking as seen as a new pattern of alcohol consumption among teenagers and young adults. Heavy alcohol consumption is detrimental to many organs and tissues, including bones. Osteoporosis is regularly mentioned as a secondary consequence of alcoholism, and chronic alcohol abuse is established as an independent risk factor for osteoporosis. The review will present the different mechanisms and effects of alcohol intake on bone mass, bone metabolism, and bone strength, including alcoholism-related "life-style factors" such as malnutrition, lack of exercise, and hormonal changes as additional causative factors, which also contribute to the development of osteoporosis due to alcohol abuse.

Comparison of Bone Mineral Density among Alcoholism and Nonalcoholism Athlete and Nonathlete Subjects

BACKGROUND

The aim of this study was to compare bone mineral density among alcoholic, nonalcoholic and nonathlete subjects.

MATERIALS AND METHODS

The group consisted of physically active people. A questionnaire was given to both alcoholics and nonalcoholics and 28 persons were randomly selected (15 members who consumed alcohol and 13 who did not). In order to collect the data on mineral aggregation, a testing device (DEXA) was used. The data were analyzed using SPSS software.

RESULTS

It was found that higher bone aggregation in each of the two athletic group in comparison with the nonathletic group (p < 0.05).

CONCLUSION

Exercise may have a positive impact on bone mineral density.

ABBREVIATIONS

BMD: bone mineral density; SPSS: Statistical package for social science.How to cite this article: Hosseini S, Valizade R, Heydarabadi FD. Comparison of Bone Mineral Density among Alcoholism and Nonalcoholism Athlete and Nonathlete Subjects. Euroasian J Hepato-Gastroenterol 2014;4(1):1-3.

Moderate alcohol use and health: a consensus document

AIMS

The aim of this consensus paper is to review the available evidence on the association between moderate alcohol use, health and disease and to provide a working document to the scientific and health professional communities.

DATA SYNTHESIS

In healthy adults and in the elderly, spontaneous consumption of alcoholic beverages within 30 g ethanol/d for men and 15 g/d for women is to be considered acceptable and do not deserve intervention by the primary care physician or the health professional in charge. Patients with increased risk for specific diseases, for example, women with familiar history of breast cancer, or subjects with familiar history of early cardiovascular disease, or cardiovascular patients should discuss with their physician their drinking habits. No abstainer should be advised to drink for health reasons. Alcohol use must be discouraged in specific physiological or personal situations or in selected age classes (children and adolescents, pregnant and lactating women and recovering alcoholics). Moreover, the possible interactions between alcohol and acute or chronic drug use must be discussed with the primary care physician.

CONCLUSIONS

The choice to consume alcohol should be based on individual considerations, taking into account the influence on health and diet, the risk of alcoholism and abuse, the effect on behaviour and other factors that may vary with age and lifestyle. Moderation in drinking and development of an associated lifestyle culture should be fostered.

Longitudinal impact of substance use and depressive symptoms on bone accrual among girls aged 11-19 years

PURPOSE

Osteoporosis is primarily evident in postmenopausal women, but its roots are traceable to periods of growth, including during adolescence. Depression, anxiety, and smoking are associated with lower bone mineral density (BMD) in adults. These associations have not been studied longitudinally across adolescence, when more than 50% of bone accrual occurs.

METHODS

To determine the impact of depressive and anxiety symptoms, smoking, and alcohol use on bone accrual in girls 11-19 years, 262 healthy girls were enrolled in age cohorts of 11, 13, 15, and 17 years. Using a cross-sequential design, girls were seen for three annual visits. Outcome measures included total body bone mineral content and BMD of the total hip and lumbar spine using dual energy x-ray absorptiometry. Depressive and anxiety symptoms and smoking and alcohol use were by self-report.

RESULTS

Higher-frequency smoking was associated with a lower rate of lumbar spine and total hip BMD accrual from ages 13-19. Higher depressive symptoms were associated with lower lumbar spine BMD across 11-19 years of age. There was no effect of depressive symptoms on total body bone mineral content, and there was no effect of alcohol intake on any bone outcome.

CONCLUSION

Adolescent smokers are at higher risk for less than optimal bone accrual. Even in the absence of diagnosable depression, depressive symptoms may influence adolescent bone accrual. These findings have import for prevention of later osteoporosis and fractures.

Association of regional body composition with bone mineral density in HIV-infected and HIV-uninfected women: women's interagency HIV study

OBJECTIVE

To understand how regional body composition affects bone mineral density (BMD) in HIV-infected and HIV-uninfected women.

METHODS

Dual energy x-ray absorptiometry was used to measure regional lean and fat mass and BMD at lumbar spine (LS), total hip (TH), and femoral neck (FN) in 318 HIV-infected and 122 HIV-uninfected Women's Interagency HIV Study participants at baseline and 2 and 5 years later. Total lean and fat mass were measured using bioimpedance analysis. Multivariate marginal linear regression models assessed the association of HIV status and body composition on BMD change.

RESULTS

Compared with HIV-uninfected women, HIV-infected women were older (44 vs. 37 years), more likely to be Hepatitis C virus-infected (32% vs. 14%), and postmenopausal (26% vs. 3%) and had lower baseline total fat mass, trunk fat, and leg fat. In multivariate models, increased total lean mass was independently associated with increased BMD at LS, TH, and FN, and total fat mass was associated with increased BMD at TH and FN (all P < 0.05). When total fat was replaced in multivariate models with trunk fat and leg fat, increased trunk fat (and not leg fat) was associated with increased TH and FN BMD (P < 0.001).

CONCLUSIONS

Total fat and lean mass are strong independent predictors of TH and FN BMD, and lean mass was associated with greater LS BMD. Regardless of HIV status, greater trunk fat (and not leg fat) was associated with increased TH and FN BMD, suggesting that weight-bearing fat may be a more important predictor of BMD in the hip.

Bone structure and geometry in young men: the influence of smoking, alcohol intake and physical activity

BACKGROUND

The development of osteoporosis is influenced by peak bone mass attained in youth - the influence of lifestyle factors upon which is poorly described, especially amongst males. We sought to address this issue in a large scale study.

METHODS

Hip bone mineral density (dual X-ray absorptiometry, DXA), bone microarchitecture (calcaneal quantitative ultrasound, QUS) and femoral geometry (magnetic resonance imaging, MRI) were characterised in 723 healthy male military recruits (mean ± S.E. age 19.92 ± 0.09 years [range 16-18 years], height 177.67 ± 0.24 cm, weight 73.17 ± 0.37 kg) on entry to UK Army training. Association was sought with prior physical activity, smoking status and alcohol intake.

RESULTS

DXA measures were made in 651, MRI measures in 650, and QUS measures in 572 recruits. Increasing levels of weight-bearing physical activity enhanced periostial bone apposition, increases in both total hip and femoral neck bone mineral density (BMD; p ≤ 0.0001 in both cases), and cortical [p<0.0001] and periostial bone volumes [p=0.016]. Smoking habit was associated with preserved bone geometry, but worse BMD [p=0.0001] and QUS characteristics [p ≤ 0.0005]. Moderate alcohol consumption was associated with greater BMD [p ≤ 0.015].

CONCLUSIONS

Whilst exercise (and perhaps moderate alcohol intake) is beneficial to bone morphometry, smoking is detrimental to bone mineral density in young males notable for the likely short duration of smoking to influence skeletal properties. However, differences in socio-economic status, lifestyle and related environmental factors may to some extent confound our results.

Predictors of bone mineral density in a convenience sample of young Caucasian adults living in southern Ontario

Osteoporosis is a major public health concern in Canada and worldwide. Although much is known about bone health in older adults, little is known about bone health in young, healthy Canadian men and women. The objectives of this research were to describe bone mineral density (BMD) of young, healthy adults living in southern Ontario, Canada, and to identify predictors of BMD in this population. Two-hundred and fifty-eight Caucasian men and women aged 18–33 years completed health and physical activity questionnaires along with a calcium and vitamin D specific food frequency questionnaire. Height and mass were measured. BMD of the total hip, femoral neck, spine, and total body was measured using dual energy X-ray absorptiometry. Among men, body mass, weight-bearing physical activity, and calcium intake were significant predictors of BMD. Among women, body mass, calcium intake, and family history of osteoporosis significantly predicted log BMD. The predictors of BMD in young Canadian men and women identified in this study may inform the development of longitudinal studies designed to examine the influence of lifestyle factors on BMD in young adults.

Alcohol consumption and bone mineral density in elderly women

OBJECTIVE

Findings regarding alcohol consumption and bone mineral density (BMD) in elderly women have been inconsistent. The objective of the present study was to explore the association of alcohol intake with BMD in elderly women.

DESIGN

This cohort study included women from the population-based Kuopio Osteoporosis Risk Factor and Prevention - Fracture Prevention Study (OSTPRE-FPS). Alcohol intake and potential confounders were assessed at baseline and after 3 years of follow-up using a lifestyle questionnaire. In addition, an FFQ was distributed in the third year to measure dietary intake, including alcohol. Women underwent BMD measurements at the femoral neck and lumbar spine at baseline and after 3 years of follow-up.

SETTING

Kuopio Province, Finland.

SUBJECTS

Three hundred elderly women (mean age 67·8 years) who provided both BMD measurements and FFQ data.

RESULTS

Alcohol consumption estimated from the FFQ and lifestyle questionnaire was significantly associated with BMD at both measurement sites after adjustment for potential confounders, including lifestyle and dietary factors (P < 0·05). Using the FFQ, women drinking >3 alcoholic drinks/week had significantly higher BMD than abstainers, 12·0 % at the femoral neck and 9·2 % at the lumbar spine. Results based on the lifestyle questionnaire showed higher BMD values for all alcohol-consuming women at the femoral neck and for women drinking 1-3 alcoholic beverages/week at the lumbar spine, compared with non-users.

CONCLUSIONS

The results from OSTPRE-FPS suggest that low to moderate alcohol intake may exert protective effects on bone health in elderly women.

Prevalence, awareness, and treatment of osteoporosis among Korean women: The Fourth Korea National Health and Nutrition Examination Survey

PURPOSE

This study aimed to assess the factors associated with the prevalence, awareness, and treatment of osteoporosis in a representative sample of Korean women.

METHODS

Data were obtained from dual energy X-ray absorptiometry measurement of the lumbar vertebrae and femoral neck, and from a standardized questionnaire in 2870 Korean women aged 50years and older who participated in the Fourth Korea National Health and Nutrition Examination Survey 2008-2009. Osteoporosis was defined by World Health Organization T-score criteria, and awareness and treatment were defined by self-report of an osteoporosis diagnosis and self-report of current anti-osteoporotic medication use, respectively. We assessed the relationship between multiple risk factors and prevalence, awareness, and treatment.

RESULTS

Osteoporosis was reported in 39.1% of Korean women. Among those with osteoporosis, only 37.5% were aware of their diagnosis and 23.5% received pharmacological treatment. Despite higher prevalence among respondents who were older, of lower body weight, calcium intake, physical activity, and education levels, the awareness and treatment rates of these groups were similar or lower than that of the low-risk controls in multivariate logistic regression models. Moreover, easily identifiable risk factors (e.g., history of fracture, falls, height loss, familial osteoporosis) were not associated with awareness and treatment. Participants who had undergone health screening in the previous 2years exhibited increased awareness and treatment rates independently of other demographic factors.

CONCLUSIONS

Osteoporosis was highly prevalent in this Korean study but was underdiagnosed and undertreated. Routine health screenings could be an effective strategy to increase osteoporosis awareness and treatment.

Alcohol and bone: review of dose effects and mechanisms

Alcohol is widely consumed across the world. It is consumed in both social and cultural settings. Until recently, two types of alcohol consumption were recognized: heavy chronic alcohol consumption or light consumption. Today, there is a new pattern of consumption among teenagers and young adults namely: binge drinking. Heavy alcohol consumption is detrimental to many organs and tissues, including bones, and is known to induce secondary osteoporosis. Some studies, however, have reported benefits from light alcohol consumption on bone parameters. To date, little is known regarding the effects of binge drinking on bone health. Here, we review the effects of three different means of alcohol consumption: light, heavy, and binge drinking. We also review the detailed literature on the different mechanisms by which alcohol intake may decrease bone mass and strength. The effects of alcohol on bone are thought to be both direct and indirect. The decrease in bone mass and strength following alcohol consumption is mainly due to a bone remodeling imbalance, with a predominant decrease in bone formation. Recent studies, however, have reported new mechanisms by which alcohol may act on bone remodeling, including osteocyte apoptosis, oxidative stress, and Wnt signalling pathway modulation. The roles of reduced total fat mass, increased lipid content in bone marrow, and a hypoleptinemia are also discussed.

Diet and bone mineral density study in postmenopausal women from the TwinsUK registry shows a negative association with a traditional English dietary pattern and a positive association with wine

BACKGROUND

The effect of diet on bone mineral density (BMD) remains controversial, mainly because of difficulties in isolating dietary factors from the confounding influences of age, lifestyle, and genetic factors.

OBJECTIVE

The aim of this study was to use a novel method to examine the relation between BMD and diet.

DESIGN

A co-twin control study design with linear regression modeling was used to test for associations between BMD and habitual intakes of calcium, vitamin D, protein, and alcohol plus 5 previously identified dietary patterns in postmenopausal women from the TwinsUK registry. This approach exploited the unique matching of twins to provide an estimate of an association that was not confounded by age, genetic background, or shared lifestyle.

RESULTS

In >2000 postmenopausal women (BMD data on 1019, 1218, and 1232 twin pairs at the hip neck, hip, and spine, respectively), we observed a positive association between alcohol intake (from wine but not from beer or spirits) and spine BMD (P = 0.01) and a negative association with a traditional 20th-century English diet at the hip neck (P = 0.01). Both associations remained borderline significant after adjustment for mean twin-pair intakes (P = 0.04 and P = 0.055, respectively). Other dietary patterns and intakes of calcium, vitamin D, and protein were unrelated to BMD.

CONCLUSION

Our results showed that diet has an independent but subtle effect on BMD; wine intake was positively associated with spine BMD, whereas a traditional (20th-century) English diet had a negative association with hip BMD.

Bone mass, depressive, and anxiety symptoms in adolescent girls: variation by smoking and alcohol use

PURPOSE

The purpose of the study was to examine (a) the association between depressive and anxiety symptoms with bone health, (b) the association of smoking or alcohol use with bone health, and, in turn (c) whether the association between depressive and anxiety symptoms with bone health varied by smoking or alcohol use individually or by combined use. Bone health included total body bone mineral content (TB BMC) and bone mineral density (BMD) of the lumbar spine, total hip, and femoral neck. Previously published data have not examined these issues in adolescence, a period when more than 50% of bone mass is accrued.

METHODS

An observational study enrolled 262 healthy adolescent girls by age cohort (11, 13, 15, and 17 years). Participants completed questionnaires and interviews on substance use, depressive symptoms, and anxiety. BMC and BMD were measured by dual-energy X-ray absorptiometry.

RESULTS

Higher depressive symptoms were associated with lower TB BMC and BMD (total hip, femoral neck). Those with the lowest level of smoking had higher BMD of the hip and femoral neck, whereas no main effect differences were noted by alcohol use. Regular users of both cigarettes and alcohol demonstrated a stronger negative association between depressive symptoms and TB BMC as compared with nonusers/experimental users and regular alcohol users. Findings were parallel for anxiety symptoms.

CONCLUSION

Depressive and anxiety symptoms may negatively influence bone health in adolescent girls. Consideration of multiple substances, rather than cigarettes or alcohol separately, may be particularly informative with respect to the association of depression with bone health.

A twin approach to unraveling epigenetics

The regulation of gene expression plays a pivotal role in complex phenotypes, and epigenetic mechanisms such as DNA methylation are essential to this process. The availability of next-generation sequencing technologies allows us to study epigenetic variation at an unprecedented level of resolution. Even so, our understanding of the underlying sources of epigenetic variability remains limited. Twin studies have played an essential role in estimating phenotypic heritability, and these now offer an opportunity to study epigenetic variation as a dynamic quantitative trait. High monozygotic twin discordance rates for common diseases suggest that unexplained environmental or epigenetic factors could be involved. Recent genome-wide epigenetic studies in disease-discordant monozygotic twins emphasize the power of this design to successfully identify epigenetic changes associated with complex traits. We describe how large-scale epigenetic studies of twins can improve our understanding of how genetic, environmental and stochastic factors impact upon epigenetics, and how such studies can provide a comprehensive understanding of how epigenetic variation affects complex traits.

Substance use and women's health

Scientific findings show that substance abuse in women yields a higher risk of a variety of health problems than substance abuse in men. Research suggests that women experience addiction telescoping when they abuse alcohol, tobacco, specific stimulants, and possibly opioids. Medical side effects also develop more rapidly in women than men when they abuse many substances. Cancer and cardiac complications, specifically, pose a significant threat for women who abuse almost all types of substances. However, the physical consequences are not the only ones women suffer when they engage in substance abuse. Research on substance abuse in women ties opioids to mood and anxiety disorders, heroin to neurological deficiencies, cocaine to immune system suppression, and alcohol to intimate partner abuse. Additionally, female substance abusers, on average, have a lower level of education and lower rates of employment. In light of these gender-specific concerns, physicians should give particular consideration to detecting substance abuse in women.

Alcohol alters whole body composition, inhibits bone formation, and increases bone marrow adiposity in rats

Chronic alcohol abuse is a risk factor for osteoporosis and sarcopenia, but the long-term effects of alcohol on the immature musculoskeletal system are less clear. The present investigation in growing rats was designed to determine the effects of alcohol consumption on body composition, muscle mass, and bone mass, architecture, and turnover.

INTRODUCTION

Few studies have focused on the long-term effects of drinking on bone and muscle during skeletal maturation.

METHODS

Alcohol was included in the diet of 4-week-old male Sprague-Dawley rats (35% caloric intake) for 3 months. The controls were fed an isocaloric alcohol-free liquid diet ad libitum. A second study was performed in which the controls were pair-fed to the alcohol-fed animals.

RESULTS

Compared to ad libitum-fed age-matched controls, alcohol-fed rats weighed less and had lower lean mass, fat mass, and percent body fat. In addition, they had lower slow- and fast-twitch muscle mass, lower total body bone mineral content and bone mineral density, and lower cancellous bone volume in the lumbar vertebra and proximal tibia. The effects of alcohol consumption on body composition were reduced when compared to the pair-fed control diet, indicating that caloric restriction was a comorbidity factor. In contrast, the effects of alcohol to decrease bone formation and serum leptin and IGF-I levels and to increase bone marrow adiposity appeared independent of caloric restriction.

CONCLUSIONS

The skeletal abnormalities in growing alcohol-fed rats were due to a combination of effects specific to alcohol consumption and alcohol-induced caloric restriction.

Epidemiology and genetic epidemiology of the liver function test proteins

Background

The liver function test (LFT) is among the most commonly used clinical investigations to assess hepatic function, severity of liver diseases and the effect of therapies, as well as to detect drug-induced liver injury (DILI).

Aims

To determine the relative contribution of genetic and environmental factors as well as test and quantify the effects of sex, age, BMI and alcohol consumption to variation in liver function test proteins - including alanine amino transaminase (ALT), Albumin, gamma glutamyl transpeptidase (GGT), total bilirubin, total protein, total globulin, aspartate transaminase (AST), and alkaline phosphotase (ALP) - using the classical twin model.

Methods

Blood samples were collected from a total of 5380 twin pairs from the TwinsUK registry. We measured the expression levels of major proteins associated with the LFT, calculated BMI from measured weight and height and questionnaires were completed for alcohol consumption by the twins. The relative contribution of genetic and environmental factors to variation in the LFT proteins was assessed and quantified using a variance components model fitting approach.

Results

Our results show that (1) variation in all the LFTs has a significant heritable basis (h² ranging from 20% to 77%); (2) other than GGT, the LFTs are all affected to some extent by common environmental factors (c² ranging from 24% to 54%); and (3) a small but significant proportion of the variation in the LFTs was due to confounding effects of age, sex, BMI, and alcohol use.

Conclusions

Variation in the LFT proteins is under significant genetic and common environmental control although sex, alcohol use, age and BMI also contribute significantly to inter-individual variation in the LFT proteins. Understanding the underlying genetic contribution of liver function tests may help the interpretation of their results and explain wide variation among individuals.

One-per-occasion or less: are moderate-drinking postmenopausal women really healthier than their nondrinking and heavier-drinking peers?

BACKGROUND

While some reported benefits of moderate drinking are thought to be the direct results of physiological mechanisms associated with consumption, other effects may be attributable to mediating factors. Both explanations suggest that moderate drinkers may be healthier than nondrinking and heavier-drinking peers. The purpose of this study was to determine whether moderate-drinking postmenopausal women report healthier dietary and exercise patterns, and whether they demonstrate better physiological functioning compared with peers. This study also aimed to describe patterns of relationships between alcohol and measures of general health functioning in postmenopausal women.

METHODS

One-hundred and fifteen women aged 50 to 65 participated. Participants completed alcohol interviews, diet and exercise questionnaires, and bone density examination. Blood pressure, height, and weight were assessed, and blood was collected to conduct basic chemistry and complete blood count tests.

RESULTS

Postmenopausal moderate drinkers failed to demonstrate healthier dietary or exercise habits, and did not exhibit significantly better health-functioning compared with peers. They did evidence positive associations between drinking and healthy behavior, and between drinking and cardiovascular health. Relationships between alcohol and blood analytes differed between drinking groups, some of which suggested possible negative health consequences for higher-end drinkers in both drinking groups.

CONCLUSIONS

These data suggested that moderate-drinking postmenopausal women are not significantly healthier than their non- or heavier-drinking peers, but may drink as part of a larger effort to take care of their health. Despite this, even 1-drink-per-drinking-day moderate drinkers may have tendencies toward unhealthy conditions. Limitations include small sample size, inability to assess specific cardiac risk and socioeconomic status, small number of correlations, and clinical relevance of analyte values.

Association between alcohol consumption and both osteoporotic fracture and bone density

OBJECTIVE

Alcoholism is a risk factor for osteoporotic fractures and low bone density, but the effects of moderate alcohol consumption on bone are unknown. We performed a systematic review and meta-analysis to assess the associations between alcohol consumption and osteoporotic fractures, bone density and bone density loss over time, bone response to estrogen replacement, and bone remodeling.

METHODS

MEDLINE, Current Contents, PsychINFO, and Cochrane Libraries were searched for studies published before May 14, 2007. We assessed quality using the internal validity criteria of the US Preventive Services Task Force.

RESULTS

We pooled effect sizes for 2 specific outcomes (hip fracture and bone density) and synthesized data qualitatively for 4 outcomes (non-hip fracture, bone density loss over time, bone response to estrogen replacement, and bone remodeling). Compared with abstainers, persons consuming from more than 0.5 to 1.0 drinks per day had lower hip fracture risk (relative risk=0.80 [95% confidence interval, 0.71-0.91]), and persons consuming more than 2 drinks per day had higher risk (relative risk=1.39 [95% confidence interval, 1.08-1.79]). A linear relationship existed between femoral neck bone density and alcohol consumption. Because studies often combined moderate and heavier drinkers in a single category, we could not assess relative associations between alcohol consumption and bone density in moderate compared with heavy drinkers.

CONCLUSION

Compared with abstainers and heavier drinkers, persons who consume 0.5 to 1.0 drink per day have a lower risk of hip fracture. Although available evidence suggests a favorable effect of alcohol consumption on bone density, a precise range of beneficial alcohol consumption cannot be determined.

Evolution of bone mineral density in AIDS patients on treatment with zidovudine/lamivudine plus abacavir or lopinavir/ritonavir

OBJECTIVES

The aim of the study was to determine the factors that may contribute to decreases in bone mineral density (BMD) in patients with AIDS.

METHODS

This was a prospective, non-randomized study. Dual X-ray absorptiometry (DXA) was used to determine the BMD of the lumbar spine, femoral neck and distal radius in treatment-naïve HIV-infected male patients with AIDS before and after 1 year of treatment with zidovudine (ZDV)/lamivudine (3TC) plus abacavir (ABC) or lopinavir/ritonavir (LPV/r).

RESULTS

Basal DXA was performed in 50 patients with CD4 counts <200 cells/microL and/or any AIDS-defining condition. Thirty-two patients completed 1 year with full adherence (17 on ABC and 15 on LPV/r) and a second DXA was then performed. At baseline, 19% had osteopenia at the lumbar spine and 19% at the femoral neck. Low body weight was related to low BMD. After 48 weeks, BMD loss was significant at the three locations. The percentage of BMD loss at the femoral neck tended to be greater in the lopinavir group (5.3 vs. 3.2%, P=0.058). The differences became significant at the lumbar spine (5.7 vs. 2.7%, P=0.044). In the multivariate analysis, the treatment with LPV/r remained associated with bone loss at the lumbar spine.

CONCLUSIONS

Osteopenia is frequent in treatment-naïve HIV-infected men with AIDS. Bone loss is higher with LPV/r-based regimens compared with triple nucleoside reverse transcriptase inhibitors.

Aberrant expression of BAFF by B lymphocytes infiltrating the salivary glands of patients with primary Sjögren's syndrome

OBJECTIVE

To identify the cells that produce BAFF in the salivary glands of patients with primary Sjögren's syndrome (SS), and to analyze BAFF receptor expression by local T and B lymphocytes.

METHODS

We used 3 methods to identify the source of BAFF: in situ hybridization of the transcripts for BAFF combined with staining of membrane markers, regular and real-time reverse transcription-polymerase chain reaction (RT-PCR) of cultured epithelial cells, and RT-PCR of sorted single-cell T and B lymphocytes eluted from salivary glands. Cells expressing TACI, BCMA, and B lymphocyte stimulator receptor 3 (BR-3) were disclosed by combining each specific staining of the receptors with each specific staining of the cells. The function of BAFF generated by epithelial cells on B lymphocytes was determined in short-term cocultures.

RESULTS

Transcripts for BAFF were seen in epithelial cells and infiltrating T lymphocytes and, for the first time, were detected in local B cells. It is interesting that BR-3 was present on these B cells but not on T cells. In contrast, TACI and, to a lesser degree, BCMA were observed on transitional B lymphocytes, whereas T lymphocytes were devoid of receptors for BAFF. Furthermore, this cytokine was shown to be functional, in that epithelial cell-bound BAFF extended the survival of normal B cells, but cell-free BAFF released in the supernatants did not.

CONCLUSION

These experiments establish that in primary SS, BAFF is produced not only by epithelial cells and T cells but also by B cells. The expression of receptors for BAFF would thus allow these receptors to participate in an autocrine pattern of self-stimulation.

Bone density in relation to alcohol intake among men and women in the United States

Studies of postmenopausal women have shown a positive association between BMD and alcohol intake. We found that BMD was higher in men, and possibly postmenopausal women, who drank alcohol compared with those who abstained. Drinking alcohol, but not binge drinking, may benefit bone health of men and postmenopausal women.

INTRODUCTION

Osteoporotic fractures account for over 2.5 million physician visits annually for persons ages >or=45 years in the United States. Studies of postmenopausal women show a positive association between bone mineral density (BMD) and alcohol intake, but for men and premenopausal women, the bone-alcohol relationship remains unclear. We examined the association between total hip (TH) and femoral neck (FN) BMD and alcohol intake of men and pre- and postmenopausal women.

METHODS

We conducted multiple regression analyses using data from 13,512 persons ages >or=20 years from the Third National Health and Nutrition Examination Survey, 1988-1994. Alcohol intake and binge drinking were measured by questionnaire and hip BMD by dual energy X-ray absorptiometry (DXA).

RESULTS

Accounting for covariates, TH BMD was higher in men (n = 6,868) who had 5-29 (+2.1%, p < 0.01) and >29 drinking occasions/month (+1.7%, p < 0.05) than men who abstained. BMD of premenopausal women (n = 4,136) who drank alcohol did not differ from those who abstained. FN BMD was 3.8% higher in postmenopausal women (n = 2,043) who had >29 drinking occasions/month than those who abstained (p = 0.06). Binge drinking was not associated with BMD of men or women.

CONCLUSIONS

Drinking alcohol, but not binge drinking, appears to be beneficial to bone health of men and possibly postmenopausal women.

Factors affecting patella cartilage and bone in middle-aged women

OBJECTIVE

To evaluate the effects of age, physical activity, and body mass index (BMI) on patella cartilage volume and defects and bone volume in middle-aged women without knee pain.

METHODS

Magnetic resonance imaging was performed in 176 healthy women, ages 40-67 years, without knee pain to measure patella cartilage and bone volume and patella cartilage defects. The effects of age, physical activity, BMI, smoking, and alcohol were analyzed to determine whether associations existed between these variables and patella cartilage and bone volume and cartilage defects.

RESULTS

Patella cartilage volume decreased with age (P = 0.01) and BMI (P = 0.05) after adjusting for age and patella bone volume. Patella bone volume was positively associated with body height in both the univariate and multivariate models. Cartilage defects in the patellofemoral compartment were present in 36.4% of the study population. Age, weight, and BMI were positively associated with the presence of cartilage defects in the multivariate analysis.

CONCLUSION

This study demonstrated that although age is positively associated with both patella bone volume and cartilage defects, it is inversely associated with patella cartilage volume in healthy individuals. Moreover, BMI is inversely associated with both patella cartilage volume and patella bone volume in middle-aged women without knee osteoarthritis. Longitudinal studies will be required to determine whether avoiding a high BMI will reduce the risk of developing patellofemoral osteoarthritis.