Liverpool Medical School, , Liverpool, UK.
Postgrad Med J. 2013 Oct;89(1056):578-83. doi: 10.1136/postgradmedj-2013-131990. Epub 2013 Jul 26.
Alcohol abuse is increasing in the UK and contributes significantly to the rising number of acute hospital admissions. The effects are increasingly seen among younger people who binge drink. The effects of excess alcohol on the skeleton have attracted far less attention than those on other organs, but the risk of fractures at important sites, such as the hips and vertebrae, is greatly increased in alcoholics. This is partly owing to reductions in bone mineral density, but other factors such as an increased rate of falls play an important part. The contribution of excess alcohol consumption to the risk of fractures is recognised in the widely available fracture assessment tool (FRAX). The mechanisms of fracture in alcohol abusers are complex and involve direct effects on bone cells, and indirect effects, mediated by alcohol, on the endocrine system, pancreas and cytokine system. Poor nutrition, with a reduction in body mass index and vitamin D levels, often contributes significantly. Prevention and treatment of fractures in alcohol abusers has received limited attention, and there are surprisingly few therapeutic trials to guide clinical intervention. Abstinence has been shown to improve markers of bone turnover within 2 months. However, compliance with oral therapeutic agents is often poor, and bisphosphonates may be contraindicated in patients with alcoholic liver disease and varices. The emergence of newer therapeutic options may facilitate controlled prospective studies of the role of parenteral agents in providing protection against both primary and secondary osteoporotic fractures among patients with alcohol abuse.
在英国，酗酒现象日益严重，导致急性住院人数不断增加。酗酒者中越来越多的年轻人出现狂饮现象，这导致了这种情况的发生。过量饮酒对骨骼的影响远不如对其他器官的影响受到关注，但酗酒者髋部和脊椎等重要部位骨折的风险大大增加。这部分是由于骨密度降低，但其他因素，如跌倒率增加，也起着重要作用。在广泛使用的骨折评估工具（FRAX）中，已经认识到过量饮酒对骨折风险的影响。酗酒者骨折的机制很复杂，包括对骨细胞的直接影响，以及酒精对内分泌系统、胰腺和细胞因子系统的间接影响。营养不良也经常起重要作用，表现为体重指数和维生素 D 水平降低。预防和治疗酗酒者的骨折问题尚未得到充分关注，指导临床干预的治疗试验也少得惊人。戒酒可在 2 个月内改善骨转换标志物。然而，口服治疗药物的依从性往往很差，并且对于患有酒精性肝病和静脉曲张的患者，双磷酸盐可能是禁忌的。新的治疗选择的出现可能会促进对静脉注射药物在预防酒精滥用患者原发性和继发性骨质疏松性骨折中的作用进行对照前瞻性研究。
