Alcohol consumption has long been studied for being detrimental to bones.
The irony wasn’t lost on me.
Here we were at a recent social event and she was already on her third glass of wine. No, I wasn’t counting. She told me this when she offered to pour me a glass of wine. I turned her down politely.
It was then that we struck up a conversation. I only knew her vaguely and the inevitable question about what I did arrived.
So, I told her about My Menopause Transformation and how I’ve used my physiology and women’s health and ageing knowledge to position this stage of life in lifestyle science.
“Oh, my Doctor has already put me on menopause HRT” she said, waving her wine glass at me. “I was told by her that every woman needs it for her bone health.”
My smile belied my real thoughts. My mind was saying ‘well, why are you drinking so much alcohol then? Bone mineral density is known to be reduced with alcohol consumption – surely your Doctor would have told you to stop drinking when you went on menopause HRT?’ It would seem not, as she filled her glass again from the now nearly empty bottle.
The incident reminded me of my time at the Women’s Health conference in America – the double-standards of the Pharmaceutical company promoting their latest and greatest menopause medications and menopause HRT – yes, as global production of menopause HRT can’t keep up, especially for the HRT-patch which is currently experiencing a world-wide shortage, the pharmaceutical companies are doing their best to come up with new menopause medications.
While the wine was free-flowing to those attending (mainly Physicians), I noted from the brochure information, in very small writing that the combination of this particular HRT and alcohol, increases hot flashes/ flushes and reduces bone mineral density … two of the very things that the HRT is supposed to reverse.
How Alcohol Affects Bone Density and Osteoporosis Risk
Excess alcohol intake affects hormonal balance.
‘Alcohol’s Harmful Effects on Bone’ was the title of one of the very first papers written by scientist, Dr Wayne Sampson (PhD) nearly 30 yrs ago.
His work is now backed up by more recent research on the effects that alcohol consumption has (especially alcohol consumption over a longer period of time), on bone mineral density. (Godos et al, 2022).
Bone is a major storage site for calcium and other important minerals. Alcohol disrupts this storage process in a number of ways:
- Alcohol affects the hormones that regulate and influence calcium metabolism – this includes kidney hormones and growth hormones.
- Alcohol disrupts calcium absorption from the small intestine.
- Alcohol disrupts ‘activated’ Vitamin D (after it has undergone modification in the liver and kidneys), which in turn means that calcium absorption may be reduced in the small intestine. Vitamin D levels are especially low in the presence of alcoholic liver disease too and many women already have gut health concerns during and after menopause.
The link between calcium absorption, vitamin d and alcohol
Alcohol disrupts calcium absorption from the small intestine.
Alcohol disrupts ‘activated’ Vitamin D (after it has undergone modification in the liver and kidneys), which in turn means that calcium absorption may be reduced in the small intestine. Vitamin D levels are especially low in the presence of alcoholic liver disease too and many women already have gut health concerns during and after menopause.
Protecting bone health as we age is one of the most important factors to focus on for midlife and older women. There is so much emphasis on heavy resistance-training and menopause HRT (hormone replacement therapy) to mitigate bone-health, and yes, based on current medical recommendations, these strategies have evidence behind them.
However, what also has evidence behind it, is the fact that if your clients are drinking more than one glass of alcohol in one sitting and they have been doing this over many years, then their bone mineral density may be reduced considerably. As reported in the International Journal of Environmental Research and Public Health (Godos et al, 2022),
‘There is consistent evidence that increased alcohol consumption (more than 1 glass daily) is associated with higher risk of osteoporotic hip fracture.’
We all know that drinking culture is big business in many parts of the world. I’m reminded of this every time I come through the duty-free section of the airports and people flock to buy their booze.
There’s nothing wrong with having some alcohol of course, but with encouragement from others and because women often feel exhausted and may not be coping with their menopause symptoms, a few glasses of wine or other alcohol becomes their ‘pick-me-up’ at the end of the day. Their personal ‘reward’ for their busy, stressful lives.
Why does alcohol cause a hot flush/ hot flash?
It took me a long time to understand why, every time I had a glass of wine, I would experience hot flushes. My face would go very red, and my neck would follow! This is very embarrassing when you are out socially!
Since the early 1990s, research on alcohol consumption and its effect on our reproductive hormones, has shown that aromatisation is increased with alcohol consumption in both menopausal and postmenopausal women.
This is a term referring to the conversion of androgens (sex hormones) to oestrogen, which is the major source of naturally occurring oestrogens in post-menopausal women.
Alcohol consumption increases aromatization and may reduce the rate at which one type of endogenous oestrogen, oestradiol, is cleared from the blood (Gavaler and Van Thiel 1992; Ginsburg 1999; Gordon et al. 1975; Wimalasena et al. 1993).
When oestradiol isn’t cleared, fat cells may store the excess oestrogens instead.
This is how alcohol in menopause and post-menopause may exert its effects on the risk of coronary heart disease, osteoporosis, breast cancer, heat intolerance and weight gain (Tivis & Gavaler, 1994).
Alcohol intake in women also has direct effects on the liver and gastrointestinal tract. For most women, alcohol consumption is likely to have begun before menopause and to have simply continued into post-menopausal years, rather than beginning suddenly after menopause.
And during menopause, this may be a problem.
Because the enzymes that help to clear alcohol from the liver are changing and reducing with age. (Brady, 2015).
As such, alcohol may remain in the body for longer, and may negatively impact the thyroid’s role in regulating body temperature. Specifically, alcohol can interfere with the thyroid’s ability to produce the hormones (T3 and T4) that are crucial for thermoregulation. (Balhara, 2013)
When it comes to alcohol and symptoms, I’m not surprised that numerous women on the MyMT™ programmes mention similar experiences with heat intolerance and alcohol consumption.
Alcohol and Menopause Bone Density: What Practitioners Should Know
For women in post-menopause, they are further into their ageing. As such, structural changes occur to the gut, liver and thyroid, which further interferes with alcohol metabolism and removal of toxins.
Most types of alcohol don’t leave the body for 72 hours and alcohol also esterifies (changes) into oestradiol, a form of oestrogen. This can also cause low testosterone in women.
So, if your clients find that when they drink alcohol hot flashes increase and they are putting on weight, whether they are on HRT or not, then remind them that excess oestradiol gets stored in fat cells and of course, this includes breast tissue storage.
Breast tissue has the highest affinity to oestradiol, because of the numerous oestrogen receptors.
It’s no surprise that the World Health Organisation (WHO) has now listed alcohol as a major risk for breast cancer. Alcohol causes at least seven types of cancer, including the most common cancer types, such as bowel cancer and female breast cancer. (WHO, 2023).
Over the past year, I’ve had the privilege of educating Sarah Rusbatch from Australia, on my Menopause Practitioner Course. Sarah’s own story and journey has led her to where she is today – helping women to ditch the booze. They possibly don’t know how important this is, not only to their mental health and menopause symptoms, but also to their bone health and risk of osteoporosis.
If your clients feel that they need help and support with alcohol reduction, then please explore Sarah’s great work at Grey Area Drinking. She has also just released a book on this very topic called ‘Beyond Booze’ and it takes readers through a step-by-step process for removing alcohol.
Oestrogen plays a crucial role in maintaining bone density and reducing inflammation. Which is why, it is known that its decline during and after menopause may lead to osteoporosis, increased joint pain, and osteoarthritis. This is partly why women are placed on HRT and encouraged to do heavy resistance training.
However, as Coaches and Practitioners, it’s important to take an integrated view of all of the causes of lowered bone density risk in midlife and older women and I hope that this article has helped you better understand that moderate to high alcohol consumption can disrupt the ongoing balance between the erosion and the remodeling of bone tissue, contributing to brittle bones as women age.
This imbalance results in part from alcohol induced inhibition of osteoblasts, specialised cells that deposit new bone and I talk about this and numerous other joint health changes in the Practitioner Joint Health mini-course, which is available for you online, anytime. My video about this is below for you.
Dr Wendy Sweet (PhD), MyMT™ Founder & Member: Australasian Society of Lifestyle Medicine
References:
Balhara YP, Deb KS. Impact of alcohol use on thyroid function. Indian J Endocrinol Metab. 2013 Jul;17(4):580-7. doi: 10.4103/2230-8210.113724.
Godos J, Giampieri F, Chisari E, Micek A, Paladino N, Forbes-Hernández TY, Quiles JL, Battino M, La Vignera S, Musumeci G, Grosso G. Alcohol Consumption, Bone Mineral Density, and Risk of Osteoporotic Fractures: A Dose-Response Meta-Analysis. Int J Environ Res Public Health. 2022 Jan 28;19(3):1515. doi: 10.3390/ijerph19031515. PMID: 35162537
Pohl K, Moodley P, Dhanda AD. Alcohol’s Impact on the Gut and Liver. Nutrients. 2021 Sep 11;13(9):3170. doi: 10.3390/nu13093170.
Sampson HW. Alcohol’s harmful effects on bone. Alcohol Health Res World. 1998;22(3):190-4. PMID: 15706795
https://alcohol.org/health-effects/hrt-and-alcohol/
WHO (2023). https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health
Alcohol, Osteoporosis & Bone Health: Frequently Asked Questions
Yes, moderate to high alcohol consumption over time can contribute to reduced bone mineral density and increase the risk of osteoporosis. Alcohol interferes with calcium absorption, vitamin D activation, and bone-forming cells (osteoblasts), all of which are crucial for maintaining strong bones.
Alcohol disrupts calcium metabolism, lowers activated vitamin D, and interferes with hormonal balance—factors that collectively weaken bone density during and after menopause. This makes bones more brittle and increases fracture risk.
Yes. Alcohol increases aromatisation, leading to higher oestrogen levels and may trigger or worsen hot flashes due to disrupted hormone clearance and thermoregulation, especially as liver and thyroid function slow with age.
Wendy highlights that some HRT brands note increased hot flashes and reduced bone density when combined with alcohol. Women on HRT should be especially mindful of their alcohol intake.
Research cited in the article notes that more than one glass of alcohol per day is consistently linked to a higher risk of osteoporotic fractures, particularly hip fractures.
