The association between alcohol intake and the World Health Organization's criteria T-score groups in postmenopausal women
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BACKGROUND: There is some evidence showing that moderate intake of alcohol consumption may be associated with increased bone mineral density, especially in postmenopausal women, however not all studies have supported this association. Some of the inconsistency may be a result of assessment of alcohol intake in a limited number of ways and at different lifetime points, making comparisons different. Studies that can assess the association of both amounts of alcohol intake and patterns of intake across various critical time periods in relation to bone density in postmenopausal women may help public health practitioners to better understand the relationship. OBJECTIVE: To determine if there was an association between alcohol intake amount, patterns, and times of exposure on WHO defined categories of osteoporosis at the hip among postmenopausal women. METHODS: This study was conducted in 1,362 postmenopausal participants enrolled in the Buffalo OsteoPerio Study, which is an ancillary study in the Buffalo participants of the Women's Health Initiative (WHI). Different patterns of alcohol consumption, (lifetime consumption, consumption during critical time points in the past, current consumption, recent consumption within the past 3 months, recent consumption within the past 12 months, recent consumption of either wine, beer, or liquor in the past 12 months, recent frequency of consumption within the past 3 months, consumption not around a major meal and frequency of drinking more than usual on special occasions) were assessed through several different questionnaires completed as part of participation in the WHI and the Buffalo OsteoPerio Study. Bone mineral density was assessed by Dual Energy X-Ray Absorptiometry (DXA) of the antero-posterior spine, total hip, femoral neck, wrist and total body sites. T-scores (standard deviation from young, normal people) were yielded from the DXA. They were then converted to WHO defined criteria groups (normal, low bone mass, osteoporosis). Crude and adjusted multinomial logistic regression analyses were used to assess the relationship between alcohol intake and WHO criteria T-score groups. We focused on the total hip for this analysis. Final models were adjusted for age, pack-years of smoking, race/ethnicity, and general smoking status (never, former, and current). RESULTS: The mean (± standard deviation) age of the study participants was 66.49±6.99 years. Furthermore, the cohort was predominately white (97.47%). Participants were significantly more likely to be drinkers if they were between ages 60-69, smokers, had attended college, or were current hormone therapy users. Older women were most likely to be osteoporotic compared to younger women. The mean age (± standard deviation) of women in the osteoporosis group was 72.13±6.48 years, compared to 65.16±6.71 years in the normal bone group and 68.42±6.80 in the osteopenia group. In the multinomial logistic regression analysis, there was a suggestion of a protective effect against osteopenia and osteoporosis for high alcohol consumption. However, none of the crude or adjusted associations reached statistical significance. For example, alcohol consumption `at age 14-17 (reference group was never drinker, or consumed less than 12 drinks ever), having 1-3 drinks each month during that life period was more protective against osteopenia than having none or less than 1 drink per month, or having more than three drinks each month. The adjusted OR for osteopenia when having 1-3 drinks each month was 0.678 (95% CI 0.284, 1.619), whereas for none or less than 1 drink per month the adjusted OR was 0.940 (95% CI 0.479, 1.846) and for more than 3 drinks the adjusted OR was 0.950 (95% CI 0.335, 2.690). However, the ORs for osteoporosis are very different. The adjusted OR is not protective against osteoporosis for those who drank 1-3 drinks each month during ages 14-17 (adjusted OR1.183, 95% CI 0.170, 8.247). When observing current alcohol consumption (referent group was non drinker), it is shown that all of the groups within that variable are protective against osteopenia, yet they are not protective against osteoporosis. After adjusting for age, pack years, race, and smoking status, drinking less than 1 drink per week was the most protective against osteopenia The lowest OR for osteoporosis was for those who drink <1 drink per month. The highest odds for osteopenia were among those who drink <1 drinks per month, whereas the highest odds for osteoporosis was among past drinkers. Although this study focused on the hip, analyses of other body sites also showed no significant associations. CONCLUSIONS: In this cross-sectional study, the results suggested that there was no association of various patterns and lifetime points of alcohol intake and amount, and WHO criteria T-score categories for the total hip in postmenopausal women.