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A cross-sectional study exploring useful indicators for low bone mineral density in male alcoholic patients

Authors Horai T, Hishimoto A, Otsuka I, So T, Mouri K, Shimmyo N, Boku S, Okishio N, Sora I

Received 5 October 2017

Accepted for publication 18 January 2018

Published 28 February 2018 Volume 2018:14 Pages 663—669


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Taro Kishi

Tadasu Horai,1 Akitoyo Hishimoto,1 Ikuo Otsuka,1 Tatsuhiro So,2 Kentaro Mouri,1 Naofumi Shimmyo,1 Shuken Boku,1 Noriaki Okishio,3 Ichiro Sora1

1Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan; 2So Mental Clinic, Kobe, Japan; 3Hyogo Mental Health Center, Kobe, Japan

Background: Alcohol dependence induces low bone mineral density (BMD), predicting osteoporosis, while low and moderate alcohol consumption may even increase BMD. In recent years, undercarboxylated osteocalcin (ucOC) and tartrate-resistant acid phosphatase-5b (TRACP-5b), bone turnover markers, have gained special interest as useful indicators of low BMD. However, it remains unclear whether other alcohol-related variables (eg, duration of abstinence and continuous drinking) are linked to aberrant BMD. In addition, no previous study has investigated whether ucOC or TRACP-5b is clinically useful to predict low BMD not only in the general population, but also in alcohol-dependent subjects.
Patients and methods: We recruited 275 male alcohol-dependent subjects and collected information about their drinking habits, comorbid diseases, smoking history and walking exercise behavior. BMD in each subject was determined by ultrasonography. Serum liver enzymes (AST, ALT, ALP, ChE, γ-GTP and LDH), ucOC and TRACP-5b were measured in all subjects. T-scores were calculated according to BMD for all subjects.
Results: The mean T-scores of our subjects were negatively shifted compared to the general population (-0.75±1.36 SD). We divided our subjects into a normal BMD group (n=137) and a low BMD group (n=138) according to their T-scores (T-score ≥-1 SD, normal BMD; T-score <-1 SD, low BMD). Multivariate logistic regression analysis showed that body mass index (BMI) was negatively associated with low BMD (95% CI: 0.75–0.90). By contrast, long abstinence period (95% CI: 1.40–4.21), smoking (95% CI: 1.30–5.56), hypertension (95% CI: 1.04–3.76), lactate dehydrogenase (LDH) (95% CI: 1.00–1.01) and ucOC (95% CI: 1.04–1.22) were positively associated with low BMD.
Conclusion: In alcohol-dependent males, smoking habits and higher ucOC are associated with low BMD. Our study suggests that smoking cessation may prevent lower BMD, and ucOC may predict lower BMD in alcohol-dependent individuals.

Keywords: alcohol dependence, osteopenia, undercarboxylated osteocalcin, tartrate-resistant acid phosphatase-5b, smoking, hypertension

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