Effects of Alcohol Use and Estrogen on Bone

In marked contrast with men who drink, women who drink alcohol are found, as a group, to have higher bone mass compared with women who abstain. Furthermore, the apparent beneficial effects of alcohol use are more apparent in postmenopausal women than women of reproductive age, suggesting that there might be an interaction between alcohol and estrogen. Estrogen deficiency accompanying menopause leads to bone loss, which in turn predisposes women to osteoporosis later in life. Estrogen deficiency accelerates bone remodeling, which is the process by which small areas of bone are destroyed and rebuilt, and leads to an imbalance whereby bone resorption—the part of remodeling consisting of breaking down and assimilating—exceeds bone formation. Alcohol might reduce bone loss in postmenopausal women by increasing the circulating levels of estrogen. Alternatively, alcohol might slow bone loss by acting on bone cells to reduce bone remodeling. Alcohol use has a negative effect on the immature skeleton but current understanding suggests that small quantities of alcohol may have beneficial effects on bone in older women.