Reports of research work funded by grants prior to 2015

Capital & Coast District Health Board

The effect of alcohol withdrawal on bone turnover in women with alcohol dependence

EM Dennison
Clinical Trials Unit

Outputs of the grant funding provided

To date our findings have already been presented at a number of national meetings (5^th addiction research symposium, Christchurch March 2014; National Bone Forum, Rotorua April 2014) and also an international meeting (National Osteoporosis Society meeting, Birmingham, UK November 2014).  Pilot data have been published in the journal Open Bone.  Findings from the study have been submitted to the Australian Population Health Congress, Hobart, September 2015 where the work has been accepted as a poster presentation; these data will also be submitted to the Australian and New Zealand Bone and Mineral Society meeting to be held (again in Hobart) in November 2015.  Thereafter we plan to prepare the work for publication; our hope is that the expanded study size and inclusion of control bone turnover markers will allow publication in an appropriate bone journal, such as Calcified Tissue International or Archives of Osteoporosis.  A summary of our research study and the results we found are shown below.

Introduction to the research area

Osteoporosis is a major public health problem through its association with fragility fracture.  Studies of older male alcoholics confirm that excessive alcohol consumption is detrimental to bone health but far fewer data are available in female populations; in this study we recruited young women entering a New Zealand alcohol detoxification programme and a convenient sample of controls.

Methods

We recruited cases from women admitted to the Kenepuru alcohol detoxification unit.  Healthy controls were recruited from nursing staff, students and clerical staff in the greater Wellington region.  A lifestyle questionnaire was administered to all participants and requested information on cigarette smoking, type and amount of alcohol consumed, habitual levels of physical activity, dietary calcium intake, past medical history including falls and fracture, and menstrual history to confirm premenopausal status.  Heel ultrasound was performed using a GE Achilles+ heel ultrasound machine.  Results were displayed as Broadband Ultrasound Attenuation (BUA) and Speed of Sound (SOS).  Fasting blood samples obtained on the day of admission for cases (day 1) and five days later, with blood samples also been collected fasting from healthy controls five days apart.  Blood samples were analysed to measure bone formation [serum procollagen type 1 N propeptide (P1NP)] and bone degradation [serum C-terminal cross-linking telopeptide of type 1 collagen (CTX)].

Results

We recruited 48 cases and 29 controls to this study.  Table 1 shows the prevalence of risk factors for poor bone health, and mean heel ultrasound values in the two groups.

The table shows the high frequency of falls and adult fracture among women with alcohol dependence.  This group were also less physically active, and were more likely to smoke than the controls we recruited.  Dietary calcium intake was similar in the two groups, but below the recommended level of 800 mg/day.  Heel ultrasound values were lower in the alcohol dependent group (p=0.09).  With regards to bone turnover, we observed that P1NP rose significantly over the detoxification programme (day 1: 29.9 (SD 13.2) µg/l; day 5: 36.1 (SD 15.3) µg/l, p=0.0005) but CTX change was not significant (day 0: 0.25(SD 0.15) µg/l; day 5: 0.23 (SD 0.11) µg/l, p=0.49).  In contrast, we observed no significant change in bone turnover marker levels among the control group over the 5 day period. 

Conclusions

Lifestyle factors associated with poor bone health are prevalent in female alcoholics.  Bone formation increased significantly after alcohol withdrawal but there were no corresponding changes in bone turnover markers seen in a healthy group.