Calcif Tissue Int (1988) 43:269-276 Calcified Tissue International 9 1988 Springer-Verlag New York Inc. Clinical Investigations Bone Histomorphometry, Bone Mass, and Related Parameters in Alcoholic Males Richard G. Crilly, 1 Colin Anderson, 1 David Hogan, 2 and Liliane Delaquerri6re-Richardson 1 ~Department of Medicine and Pathology, University of Western Ontario, London, Ontario; and 2Department of Medicine, Dalhousie University, Halifax, Nova Scotia Summary. Bone mass and related metabolic vari- ables were studied in 50 males known to be, or to have been, regular alcohol abusers. Subjects were divided into those who were still drinking and those who had abstained for at least 3 months, and the former further subdivided into moderate and heavy drinkers. Twenty-five had at least two atraumatic spinal crush fractures. In 25 cases, bone histomor- phometry was carried out. Lumbar bone mineral density and iliac crest bone volume were signifi- cantly lower in spinal crush fracture cases. Parathy- roid hormone, testosterone, and urinary cortisol measurements showed no difference between groups. Alkaline phosphatase and 24-hour urine hy- droxyproline were higher in osteoporotics than in nonosteoporotics. On bone histomorphometry, there were essentially no differences between those with and those without fractures in terms of bone formation and resorption parameters. Drinkers showed lower osteoid seam width and fraction of osteoid covered by osteoblasts, as well as fewer os- teoblasts per 10 cm of bone surface than abstainers. Mineralization lag time was prolonged, and miner- alization rate per day was lower in the drinkers. Osteon formation time was prolonged in the drinkers. On the resorption side, only the osteon resorption time was significantly different in the drinkers, being prolonged. The heavy drinkers, but not the moderate drinkers, had a significantly re- duced surface extent of lacunae. We conclude that alcohol consumption has clear detrimental effects on bone formation with less pronounced suppres- Send reprint requests to Dr. Richard G. Crilly, Chairman, Divi- sion of Geriatric Medicine, 801 Commissioners Road East, London, Ontario. Canada, N6C 5J1. sive effects on bone resorption. In no biochemical or hormonal measurement, however, with the ex- ception of hydroxyproline excretion and plasma al- kaline phosphatase, could those who had osteo- porosis be distinguished from those who did not. Key Words: Alcoholism -- Metabolic bone disease -- Biopsy. The association between alcohol abuse and osteo- porosis is well known. Saville [1] using postmortem material, demonstrated a reduction in fat-free bone weight in presumed alcoholic subjects. Dalrn and Lamke showed a greater than normal rate of bone loss in a small group of alcoholics [2], although Ro- ginsky et al. [3] could not demonstrate any signifi- cant differences in total body calcium between al- coholic patients and a control group. Nilsson [4] demonstrated a reduced forearm bone density in al- coholics, but this was a selected group who had at- tended an orthopedic department with fractures. It is accepted that males who sustain a hip fracture below the age of 70 have a higher than expected prevalence of chronic alcohol abuse [5], but beyond this no information is available on the prevalence or type of skeletal fractures in heavy drinkers. The precise mechanism of alcohol-induced os- teoporosis has not been elucidated. Some emphasis has been placed on the effect of alcohol on bone cell function. In vitro studies by Farley et al. [6] suggested that ethanol stimulates bone resorption and blocks the stimulation of bone formation by various agents. The results of studies in humans have been vari-