Table 2.
Main factors involved in ethanol-associated osteopenia
| Factors | Main mechanism(s) involved |
| Direct effect of ethanol | Direct effect on osteoblast function (oxidative damage). Possible effect on bone resorption (cytokines) |
| Liver disease | Decreased absorption of proteins, calcium, vitamin D, nutrients in general |
| Altered hormonal profile (altered IGF-1, vitamin D, gonadal hormones) | |
| Chronic pancreatitis | Altered absorption. Malnutrition |
| Malnutrition | Decreased osteoid synthesis. Decreased IGF-1 levels. Altered nutrient intake. Altered absorption. Increased cytokine levels? |
| Alcoholic hypogonadism | Altered trophic effect on bone and muscle |
| Alcoholic myopathy/neuropathy | Altered trophic effect on bone (probably via Wnt β catenin pathway) |
| Iron excess (increased absorption) | Interference with osteoblast function |
| Zinc deficiency (malnutrition; alcohol?) | Possibly, defective protein synthesis |
| Cytokines (IL-6; TNF-α) | Possibly, increased bone resorption |
| Lifestyle | Trauma. Bone fractures. Impaired nutrient intake |
IGF: Insulin-like growth factor; TNF: Tumor necrosis factor; IL: Interleukin.