Lack of physical activity is a known risk factor for osteoporosis, or severe bone thinning that puts you at risk for dangerous and painful fractures. Now a large study suggests that how active you are when you’re young can make all the difference in reducing your risk. It found that teens who spent the most time doing moderate to vigorous exercise were significantly less likely to have low bone mineral density by their mid-twenties.

The study, which was published in the journal JAMA Network Open, followed 2,569 people from age 12 to age 25. Researchers monitored the activity level of each participant by having them wear an accelerometer for a full week when the study began and again for a full week at age 14, 16, and 25. Participants also had bone density scans when they were around age 25.

According to the findings, “more time spent in moderate- to vigorous-intensity physical activity in adolescence was associated with greater hip bone mineral density at age 25 years,” the authors wrote. Intensity was a key factor: Teens who did plenty of light physical activity did not have a reduced risk of lower bone density in their twenties.

The authors also noted that “bursts” of high-impact activity — such as jumping rope, jogging, or playing tennis — were beneficial. That makes sense, as high-impact and weight-bearing activities stimulate cells called osteoblasts.

“Peak bone mass occurs in young adulthood and is considered to be a marker of the risk of fracture and osteoporosis in later life,” lead study author Ahmed Elhakeem, PhD, told Healio Rheumatology. “The results highlight adolescence as a potentially important period for bone development through high intensity exercise, which could benefit future bone health and prevent osteoporosis in later life.”

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The bone-building osteoporosis drug romosozumab (Evenity) significantly improves bone mineral density in the hip and lumbar spine within one year, according to new research. What’s more, when patients transition to a potent antiresorptive drug after taking romosozumab, they experience even more bone density gains.

A loss of bone mass, measured by bone mineral density, and a change in bone structure leads to osteoporosis. Bone is constantly in a state of regeneration, as the body removes old bone (known as bone resorption) and replaces it with new bone (bone formation).

Previous research has shown that teriparatide, another type of bone-building medication, boosts bone mineral density in the spine and hip when followed by an antiresorptive drug.

However, when the antiresorptive drugs are administered first (particularly denosumab and bisphosphonates like alendronate), a patient’s hip bone mineral density may decline.

In a new study presented at ACR Convergence 2020, the annual meeting of the American College of Rheumatology, researchers reviewed results from four recent, large-scale trials to determine how romosozumab may be given in sequence with antiresorptive drugs. (These are osteoporosis medications that work differently from romosozumab.)

They found that osteoporosis patients showed significantly different results when they received romosozumab before an antiresorptive treatment compared to receiving it after.

Effects on the Hips

When patients were administered bone-building romosozumab before an antiresorptive treatment, their total hip bone mineral density increased by 6 percent in one study and 6.2 percent in another study over a year of treatment.

Similarly, the total hip bone mineral density gain was 7.1 percent when patients were administered romosozumab before alendronate (Fosamax) over two years of treatment. When they were administered romosozumab before denosumab (Prolia), total hip bone mineral density gain was 8.5 percent over two years.

However, when patients took the antiresorptive drug alendronate first, total hip bone mineral density increased by just 2.9 percent with romosozumab treatment. When they received the antiresorptive drug denosumab first, total hip bone mineral density increased by only 0.9 percent.

And over the course of two years, total hip bone mineral density gain was just 3.8 percent when patients were administered romosozumab after denosumab — less than half of when romosozumab was given first.

Effects on the Spine

The researchers found similar results on bone density in the lumbar spine. When patients were administered romosozumab before antiresorptive drugs, their spine bone mineral density increased by 13.7 percent in one study and 13.1 percent in the other study over the course of a year.

Similarly, over two years, receiving romosozumab before alendronate led to a bone mineral density gain of 15.2 percent. When patients received romosozumab before denosumab, the gain was 16.6 percent.

However, when patients took alendronate first, the lumbar spine bone mineral density gain was just 9.8 percent over the course of a year. When they received denosumab first, it was only 5.3 percent.

And over the course of two years, spine bone mineral density gain was just 11.5 percent when patients received denosumab before romosozumab.

What the Results Mean

These results may have important implications for patients, especially women who have had recent or multiple fractures in adulthood, since they are at high risk for more.

“These women need medication that can build bone mineral density fast to improve bone strength and reduce the risk of fractures,” the study’s coauthor, Felicia Cosman, MD, Professor of Medicine at Columbia University College of Physician and Surgeons in New York City, said in a statement. “The standard approach that most health care providers use is to start treatment with antiresorptive medicine. However, bone-building agents like romosozumab, abaloparatide, and teriparatide reduce fracture risk faster than antiresorptive medicines.”

The results of this study could help doctors and osteoporosis patients make more effective preventive treatment choices.

“There are about two million fractures every year from osteoporosis,” said Dr. Cosman. “Patients need to know that the best option for them might be to receive a bone-building medication first, rather than an antiresorptive treatment.”

Amgen Inc., which manufactures romosozumab (Evenity), is a corporate sponsor of the Global Healthy Living Foundation.

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Although osteoporosis is more common in women than in men, new research shows that the condition going underdiagnosed and undertreated in older men.

Osteoporosis is a disease that results from a loss of bone mass (measured as bone density), and from bone structure changes. Bone is constantly replaced by the body, but most people start to slowly lose more bone tissue than their body replaces by their mid-30s — causing bones to become weaker and thinner.

When women reach menopause, this process accelerates, which can lead to bone fractures. For men, bone loss becomes a greater issue around age 70.

In a new study presented at ACR Convergence 2020, the annual meeting of the American College of Rheumatology, researchers looked at the baseline characteristics of male Medicare patients who had experienced an osteoporosis-related fracture.

In particular, they collected the data of Medicare fee-for-service (FFS) beneficiaries aged 65 or older who had a closed-fragility, or osteoporosis-related, fracture between January 2010 and September 2014. Patients with either Paget’s disease (a bone disease that also causes fragility) or any cancer except for non-melanoma skin cancer at baseline were excluded from the research.

The study included a total of 9,876 Medicare beneficiaries, 61 percent of whom were age 75 or older. Ninety percent of the patients were white and fewer than 6 percent had a standard bone mineral density test with dual energy x-ray absorptiometry (DXA) in the two years before experiencing a fracture.

About two-thirds of the patients had a history of musculoskeletal pain and nearly half had a history of opioid use one year prior to their fracture.

The most common fracture sites were the spine, hip, and ankle.

The researchers divided the patients into four groups based on their diagnoses and/or treatment of osteoporosis at baseline. They found that of all patients with a qualifying fracture:

• About 92% did not have any claim for a bone density (DEXA) test or prescription claim for osteoporosis treatment in the two years before their fracture
• 8% had been tested but not treated for osteoporosis
• 3% were treated but not tested for osteoporosis
• Only 2.1% were both tested and treated for osteoporosis

A decline in DEXA scans from 2012 to 2014 was especially high among men ages 75 and older, who have a higher risk of fracture.

The results of the study show that it’s important to better identify high-risk male patients, who may benefit from targeted osteoporosis screening and therapies earlier on.

“There is a need for consistent osteoporosis screening recommendation in men,” said the study’s co-author, Jeffrey Curtis, MD, a Professor of Medicine in the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham, in a press release. “Incorporation of these recommendations in quality-of-care measures for osteoporosis management and post-fracture care are warranted to improve health outcomes in this population.”

Dr. Curtis is also a principal investigator for ArthritisPower, our patient-centered research registry. You can use our ArthritisPower app to track your symptoms and disease activity and share your results with your doctor.

Osteoporosis can be a significant burden on patients and lead to physical symptoms, increased cost of health care, and even death. While only one quarter of patients with osteoporosis-related fractures are men, emerging evidence shows that men with osteoporotic fractures may fare worse than women.

The World Health Organization, American Association of Clinical Endocrinologists, United States Preventive Services Task Force, National Osteoporosis Foundation (NOF), and the American Academy of Family Physicians recommend screening women over 65 years of age for osteoporosis. However, there aren’t consistent guidelines for osteoporosis screening in men, said Dr. Curtis.

In fact, these groups don’t make any recommendations at all — except for the NOF, which recommends that all men over age 70 be screened, as well as men between the ages of 50 and 69 who have osteoporosis risk factors.

“Men are typically not part of routinely recommended screening with DEXA and so they are both underdiagnosed and undertreated,” said Dr. Curtis. “While many comorbidities (i.e., cardiovascular disease) are commonly recognized and treated in men, sometimes even more than in women, osteoporosis is not one of them. Even post-fracture for major fractures like a hip, rates of treatment are disappointingly low, leaving men at risk for yet another fracture.”

Dr. Curtis notes that future research should focus on better characterization of high-risk patients and existing comorbidities that may have shared risk factors. This could enable earlier identification and treatment of osteoporosis.

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When it comes to how much alcohol is healthy for adults to consume, you may have heard the oft-stated recommendation that it’s generally safe for most women to have one drink of alcohol per day and for most men to have two drinks daily. But if you have osteoporosis or low bone density (osteopenia), is it still safe to drink alcohol?

Osteoporosis is a degenerative disease that causes bones to be weakened and thinned to the point that they can fracture more easily. Alcohol can play a role in how dense bones are, the speed with which bone cells rebuild, and how your body absorbs important bone-forming nutrients. Alcohol consumption can be an important consideration when it comes to osteoporosis prevention and management.

You should talk to your physician for their recommendations about alcohol consumption and your specific health conditions, your health history, and use with medications you’ve been prescribed.

Here, learn more about considerations to keep in mind when it comes to the connection between alcohol and osteoporosis.

Is Moderate Alcohol Good or Bad for Bone Health?

Depending on which articles you read, you may come across mixed headlines about whether drinking alcohol in moderation is good or bad for your bone health.

In the past, some studies pointed out the potential benefits of alcohol for bone health: A 2008 study in the American Journal of Medicine found that people who consume about one alcoholic drink a day had lower risk of hip fractures than abstainers. Earlier British research concluded that women over 65 who consumed more than five drinks per week had lower risks of vertebral deformity than those who had one drink per week.

However, much of the research on alcohol and osteoporosis risk is observational, which means that it can’t conclude cause and effect. More recently, updated science has challenged the idea that drinking alcohol is “good” for bone health.

For example, an analysis of six studies published in the journal Drug and Alcohol Dependence earlier this year found a positive relationship between alcohol consumption and osteoporosis — in other words, that alcohol was linked with greater odds of osteoporosis. The study found that compared with abstainers:

• People who consumed 0.5 to 1 drink per day had 1.38 times the risk of developing osteoporosis.
• People who consumed 1 to 2 drinks per day had 1.34 times the risk of developing osteoporosis.
• People who consumed 2 drinks or more per day had 1.63 times the risk of developing osteoporosis.

The Challenges of Studying Alcohol Consumption

“Alcohol is very challenging to study and the variability of the results in these studies is most likely because most of the effects of moderate alcohol consumption on bone are subtle,” says Russell T. Turner, PhD, a researcher at the Skeletal Biology Laboratory at Oregon State University in Corvallis, Oregon who studies how exercise, nutrition, and lifestyle interact to influence skeletal health. “If alcohol has any beneficial or detrimental effect, it’s probably going to be over a really long term.”

Dr. Turner wrote a review paper in Clinical Reviews in Bone and Mineral Metabolism that challenged the assumption that moderate alcohol intake is considered beneficial and heavy drinking detrimental. Even small quantities of alcohol can have detrimental skeletal effects and not all studies report clinically relevant bone loss with long-duration alcohol abuse, according to the paper. Factors such as the following should be considered:

• Age
• Sex
• Skeletal site
• Age of onset of drinking
• Duration of drinking
• Comorbidities

Based on the finding that alcohol alters the peptides that influence bone metabolism, Dr. Turner says there is no way to predict which individuals are most likely to be impacted favorably or unfavorably by alcohol consumption.

In addition, alcohol consumption in many of the studies is self-reported. Study participants might have to think back on whether they had one drink a day or two over the past year, explains Dr. Turner. Their memory versus actual occurrence could lead to discrepancies. Then you have to factor in that the size of one person’s alcoholic drink (like wine) may differ significantly from person to person.

Dr. Turner worked on a review of studies published in the journal Alcoholism, Clinical, and Experimental Research that found that light-to-moderate drinking might have beneficial effects on older adults by slowing bone remodeling. However, he says, the study is not conclusive. Plus, alcohol’s effect on younger adults’ skeleton and bone remodeling is less certain. “In people who are careful, moderate drinkers, then it’s unlikely that [alcohol] is going to lead to any type of skeletal issue,” he says.

In another example, a small study in the journal Menopause on postmenopausal women found that when women stopped drinking alcohol for two weeks, they showed increased markers of bone turnover (which increases the risk of osteoporosis). When the women resumed alcohol consumption, they had slower bone turnover.

“One of the big risk factors for osteoporosis in the aging population is elevated bone turnover,” says Dr. Turner. “That influences the quality of the bone. This study suggested that in this population some alcohol might be beneficial. Lowering bone turnover in a younger, growing person, however, may not be so good. So age may be an important factor,” he says.

That said, “until we can do a controlled study and come up with a marker that shows how much alcohol someone has consumed, then one study’s going to show a positive, another study’s going to show a neutral, another study’s going to show negative impact on bone health,” says Dr. Turner. “The likely reason we’re seeing this [variability] is that, in reality, there is likely not much of a positive or negative effect [on bone health] from moderate alcohol consumption.”

Heavy Drinking and Osteoporosis

Even if the research on moderate drinking and osteoporosis is mixed, there is solid research that chronic heavy drinking does increase the risk of osteoporosis, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. A 2018 Korean study found that heavy drinking was associated with lower bone mineral density. The prevalence of osteopenia is between 34 and 48 percent among those with alcoholic liver disease and the prevalence of osteoporosis for this population is between 11 and 36 percent, according to a 2016 Indian study.

“We know that alcohol abuse can have detrimental effects on bone health,” says Dr. Turner. “What we don’t know is how much of the effect is alcohol directly on bone versus the other comorbidities that occur with alcohol abusers.”

Other associations may come into play, like poor diet; or problems with pancreatitis, diabetes, or liver disease. “All of these are known to negatively affect the skeleton,” he says. “The take-home message to the typical person is that alcohol abuse is bad. And whether it’s a direct or indirect effect on bone, it’s still a negative effect.”

One study published in the Journal of Studies on Alcohol and Drugs examined the association between heavy episodic drinking and college-age women’s bone density test scores. They defined “heavy episodic drinking” as having four or more drinks within two hours on 115 or more occasions since the start of high school, about 1.6 episodes per month over this period. The researchers found decreased bone mineral density in the vertebrae of those women who had more instances of binge drinking episodes, which suggests that heavy drinking before women have reached peak bone mass — which usually occurs by the late twenties — could negatively impact skeletal health.

On the plus side, it’s been discovered that when someone with a history of alcohol abuse abstains from drinking, their body can kick-start osteoblastic (bone-building) activity again.

How Excess Alcohol Consumption Affects Bone Density

Alcohol in excess can have negative effects on bones, muscles, and joints in a few different ways:

Vitamin and mineral absorption

Heavy drinking negatively impacts bone health because it affects nutrient absorption, says Scott Boden, MD, Professor of Orthopedic Surgery at Emory University School of Medicine and Director of the Emory Orthopaedics & Spine Center in Atlanta, Georgia.

Alcohol consumption impacts how the body absorbs calcium and vitamin D, both of which are critical for healthy bone development. “Alcohol can decrease the absorption of calcium via the intestine, or it can have effects on the pancreas and vitamin D metabolism, which can impact bone density,” says Dr. Boden.

When alcohol disrupts vitamin D and its ability to help the body absorb calcium, it impacts your body’s ability to build strong bones and overall bone density, putting you at a higher risk for fractures after falls.

Hormone production

Research finds that chronic heavy drinking can cause hormone deficiencies in men and women. Men with alcoholism may produce less testosterone, a hormone linked to the production of osteoblasts (cells that stimulate bone formation). In women, overconsumption of alcohol can decrease estrogen, which can negatively impact bone density, says Dr. Boden. Estrogen can inhibit bone breakdown and may stimulate bone formation. That’s why a decrease in estrogen during menopause is associated with bone loss.

Bone cell turnover

Too much alcohol negatively affects bone-building osteoblast cells in other ways. Chronic drinking suppresses osteoblastic differentiation of bone marrow cells that are crucial to the building process and also contribute to repair of deficient bone. This can increase the risk of bone fracture, according to research in the journal Alcoholism: Clinical and Experimental Research.

Fall risk

This may sound obvious, but the more alcohol you drink, the greater your risk for becoming intoxicated and falling, which can make osteoporotic fractures more likely if you’re already prone to thin, weak bones.

Types of Alcohol and Their Effect on Osteoporosis

Some research has suggested that beer may be “better for bone health” than other kinds of alcohol because some kinds of beer have high levels of the mineral silicon. Research in the Journal of Bone and Mineral Research found an association between greater dietary silicon intake and higher bone mineral density in the hip. Another study showed that moderate wine consumption may offer bone protection because wine is rich in phenolic compounds, strong phytoestrogens and natural antioxidants–all of which contribute to bone protection.

Other research published in the American Journal of Clinical Nutrition looked at the bone mineral density of men and women, noting that among the subjects, men tended to drink beer and women preferred wine. The men who consumed one to two drinks of beer or alcohol daily had higher bone mineral density than non-drinking men. Postmenopausal women who consumed one to two drinks per day had a higher bone mineral density in the spine and hip area than non-drinking women.

The authors concluded that the “tendency toward stronger associations between [bone density] and beer or wine, relative to liquor, suggests that constituents other than ethanol may contribute to bone health.” In other words, it may not be just the alcohol itself that plays a role in effect on bone health, but other compounds in beverages like wine, beer, and spirits.

However, more research is needed before experts are willing to concede that a particular type of alcohol is better for bone density than another. Far more important than alcohol type is simply quantity — and making sure you don’t consume excessive amounts.

Drinking Alcohol with Osteoporosis: Is It Safe?

No one would suggest that you start drinking alcohol in moderation to improve your bone health. But if moderate drinking is part of your lifestyle and you’ve been diagnosed with low bone density or osteoporosis and aren’t sure if it’s safe to have the occasional alcoholic beverage, talk to your doctor. They should take your entire health history and prescribed medications into account before making a recommendation.

Occasional consumption of alcohol is likely safe even if you’re at risk for osteoporosis, have been told you have osteopenia, or received an osteoporosis diagnosis. For many patients, “a glass of wine a day should not be an issue when combined with a well-balanced diet with calcium, vitamin D, and exercise,” says Dr. Boden.

“Whether you’re at risk or have been diagnosed with osteoporosis, if someone is having some alcohol as part of a healthy lifestyle, I don’t see that there’s likely to be any negative skeletal consequences to that,” says Dr. Turner.

To reduce your risk of falls and fractures, “make sure you’re focused on good nutrition, moderate physical activity, and a healthy lifestyle overall,” says Dr. Turner. Read more here about how to prevent osteoporosis through diet, exercise, medication, and more.