Association between alcohol consumption, smoking and bone tissue quality in Slovak young adults assessed by radial quantitative ultrasound

Authors

  • Simona Sulis Department of Anthropology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia https://orcid.org/0000-0002-1570-1470
  • Darina Falbová Department of Anthropology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia https://orcid.org/0000-0003-2672-0965
  • Alexandra Hozáková Department of Anthropology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia https://orcid.org/0009-0000-7341-5539
  • Lenka Vorobeľová Department of Anthropology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia https://orcid.org/0009-0009-2211-1581

DOI:

https://doi.org/10.52905/hbph2026.112

Keywords:

Bone health, alcohol drinking, smoking, young adults

Abstract

Background Despite well-characterised effects of smoking and alcohol on bone health in older adults, evidence remains limited regarding their impact on bone quality during peak bone mass acquisition in young adults (18–30 years).

Objectives Analysing the relationship between bone quality, alcohol consumption and smoking, considering physical activity (PA) and body composition.

Sample and methods The sample consisted of 1001 Slovak men and women aged 18–30 years (mean age, 22±2.35 years). Bone quality was measured using a quantitative ultrasound device (Sunlight MiniOmni™), which yielded Z-score data. Body composition variables, including skeletal muscle mass (SMM; kg) and per cent body fat (PBF; %), were assessed using a bioimpedance analyser (InBody 770). Additional behavioural factors, including alcohol consumption, smoking and PA, were collected using the WHO STEPS 2014 questionnaire.

Results In the regression analysis, duration of alcohol consumption positively predicted bone quality Z-scores (standardised 𝛽 = 0.172, 95% CI [0.03, 0.10], 𝑝 < 0.001), while cigarette smoking quantity was negatively associated (standardised 𝛽 = −0.113, 95% CI [−0.01,−0.00], 𝑝 = 0.042). The SNHA confirmed the findings of the previous analysis concerning alcohol (𝑟=0.19). Conversely, for smoking (𝑟=0.23), it identified an inverse relationship, noting a positive effect on bone health, a finding likely mediated by the association with alcohol consumption.

Conclusion Lifestyle risk factors, including smoking and alcohol consumption, are associated with bone tissue quality in young adults; however, due to the mixed results available in the literature and in our study, future studies are required.

References

Al-Bashaireh, A. M./Haddad, L. G./Weaver, M./Chengguo, X./Kelly, D. L./Yoon, S. (2018). The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms. Journal of Osteoporosis 2018 (1), 1–17. https://​doi.​org/​10.​1155/​2018/​1206235.

Bachrach, L. K. (2001). Acquisition of optimal bone mass in childhood and adolescence. Trends in Endocrinology and Metabolism 12 (1), 22–28. https://​doi.​org/​10.​1016/​S1043-2760(00)00336-2.

Baxter-Jones, A. D. G./Faulkner, R. A./Forwood, M. R./Mirwald, R. L./Bailey, D. A. (2011). Bone mineral accrual from 8 to 30 years of age: An estimation of peak bone mass. Journal of Bone and Mineral Research 26 (8), 1729–1739. https://​doi.​org/​10.​1002/​jbmr.​412.

Benjamini, Y./Hochberg, Y. (1995). Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing. Journal of the Royal Statistical Society 57 (1), 289–300. https://​doi.​org/​10.​1111/​j.​2517-6161.​1995.​tb02031.​x.

Benton, M. L./Jimenez, V. A./Newman, N./Gonzales, S. W./Grant, K. A./Turner, R. T./Iwaniec, U. T./Baker, E. J. (2022). Dose-response effects of alcohol on biochemical markers of bone turnover in non-human primates: Effects of species, sex and age of onset of drinking. Bone Reports 16, 101159. https://​doi.​org/​10.​1016/​j.​bonr.​2021.​101159.

Broulík, P. D./Vondrová, J./Růžička, P./Sedláček, R./Zíma, T. (2010). The Effect of Chronic Alcohol Administration on Bone Mineral Content and Bone Strength in Male Rats. Physiol Research, 599–604. https://​doi.​org/​10.​33549/​physiolres.​931799.

Burg, R. von (1982). E. M. P. Widmark, Principles and applications of medicolegal alcohol determination translated from the original publication in 1932 by R. C. Baselt. Biomedical Publications, Davis California, 166 pp., $53.00. Journal of Applied Toxicology 2 (5), IV. https://​doi.​org/​10.​1002/​jat.​2550020515.

Chakkalakal, D. A. (2006). Alcohol-Induced Bone Loss and Deficient Bone Repair. Alcoholism: Clinical and Experimental Research 29 (12), 2077–2090. https://​doi.​org/​10.​1097/​01.​alc.​0000192039.​21305.​55.

Chanprasertpinyo, W./Punsawad, C./Khwanchuea, R./Sukkriang, N./Yincharoen, P./Rerkswattavorn, C. (2023). Comparison between calcaneus quantitative ultrasound and the gold standard DXA in the ability to detect osteoporosis in chronic obstructive pulmonary disease patients. Journal of Orthopaedic Surgery and Research 18 (1), 778. https://​doi.​org/​10.​1186/​s13018-023-04211-8.

Cho, Y./Choi, S./Kim, K./Lee, G./Park, S. M. (2018). Association between alcohol consumption and bone mineral density in elderly Korean men and women. Archives of Osteoporosis 13 (1), 46. https://​doi.​org/​10.​1007/​s11657-018-0462-4.

Dei, M./Succu, C. (2024). Bone fragility in young people: significant anamnestic elements. International Journal of Bone Fragility 4 (1), 11–15. https://​doi.​org/​10.​57582/​IJBF.​240401.​011.

EUDA (2025). Statistical Bulletin 2025.

Eurostat (2024). European Health Interview Survey 2024.

Falahati-Nini, A./Riggs, B. L./Atkinson, E. J./O'Fallon, W. M./Eastell, R./Khosla, S. (2000). Relative contributions of testosterone and estrogen in regulating bone resorption and formation in normal elderly men. The Journal of Clinical Investigation 106 (12), 1553–1560. https://​doi.​org/​10.​1172/​JCI10942.

Forrest, A. R. W. (1986). The Estimation of Widmark’s Factor. Journal of the Forensic Science Society 26 (4), 249–252. https://​doi.​org/​10.​1016/​S0015-7368(86)72491-2.

Frost, H. M. (1987). Bone "mass" and the "mechanostat": a proposal. The Anatomical Record 219 (1), 1–9. https://​doi.​org/​10.​1002/​ar.​1092190104.

Gaddini, G. W./Turner, R. T./Grant, K. A./Iwaniec, U. T. (2016). Alcohol: A Simple Nutrient with Complex Actions on Bone in the Adult Skeleton. Alcoholism: Clinical and Experimental Research 40 (4), 657–671. https://​doi.​org/​10.​1111/​acer.​13000.

Geraldi, M. V./Gregori, G./Johansson, L./Hjertonsson, U./Brättemark, E./Lorentzon, M. (2025). Associations between body composition and bone loss in early postmenopausal women. Journal of Bone and Mineral Research (zjaf125), 1–8. https://​doi.​org/​10.​1093/​jbmr/​zjaf125.

Gibson, S./Ashwell, M. (2020). A simple cut-off for waist-to-height ratio (0·5) can act as an indicator for cardiometabolic risk: recent data from adults in the Health Survey for England. The British Journal of Nutrition 123 (6), 681–690. https://​doi.​org/​10.​1017/​S0007114519003301.

Godos, J./Giampieri, F./Chisari, E./Micek, A./Paladino, N./Forbes-Hernández, T. Y./Quiles, J. L./Battino, M./La Vignera, S./Musumeci, G./Grosso, G. (2022). Alcohol Consumption, Bone Mineral Density, and Risk of Osteoporotic Fractures: A Dose–Response Meta-Analysis. International Journal of Environmental Research and Public Health 19 (3), 1515. https://​doi.​org/​10.​3390/​ijerph19031515.

Groth, D./Scheffler, C./Hermanussen, M. (2019). Body height in stunted Indonesian children depends directly on parental education and not via a nutrition mediated pathway - Evidence from tracing association chains by St. Nicolas House Analysis. Anthropologischer Anzeiger; Bericht uber die biologisch-anthropologische Literatur 76 (5), 445–451. https://​doi.​org/​10.​1127/​anthranz/​2019/​1027.

Guglielmi, G./Terlizzi, F. de (2009). Quantitative ultrasond in the assessment of osteoporosis. European Journal of Radiology 71 (3), 425–431. https://​doi.​org/​10.​1016/​j.​ejrad.​2008.​04.​060.

Harrison, E. L. R./Desai, R. A./McKee, S. A. (2008). Nondaily smoking and alcohol use, hazardous drinking, and alcohol diagnoses among young adults: findings from the NESARC. Alcoholism: Clinical and Experimental Research 32 (12), 2081–2087. https://​doi.​org/​10.​1111/​j.​1530-0277.​2008.​00796.​x.

Hennen, E. M./Uppuganti, S./Visitación, N. de la/Chen, W./Krishnan, J./Vecchi, L. A./Patrick, D. M./Siedlinski, M./Lemoli, M./Delgado, R./Caestecker, M. P. de/Chang, W./Guzik, T. J./Johnson, R. W./Harrison, D. G./Nyman, J. S. (2025). Hypertension promotes bone loss and fragility by favoring bone resorption in mouse models. The Journal of Clinical Investigation 135 (20). https://​doi.​org/​10.​1172/​JCI184325.

Holmannova, D./Borsky, P./Kremlacek, J./Krejsek, J./Hodacova, L./Cizkova, A./Fiala, Z./Borska, L. (2025). High prevalence of low vitamin D status in the Czech Republic: a retrospective study of 119,925 participants. European Journal of Clinical Nutrition 79 (7), 641–652. https://​doi.​org/​10.​1038/​s41430-025-01587-0.

Ivaničová, N./Lazorčáková, E./Rajčániová, M. (2024). Food consumption patterns in Slovakia., 2024. Available online at https://​naos-be.​zcu.​cz/​server/​api/​core/​bitstreams/​38bc4c2d-8373-4dce-b2ea-4a2e8f53da86/​content.

Kalinowski, A./Humphreys, K. (2016). Governmental standard drink definitions and low‐risk alcohol consumption guidelines in 37 countries. Addiction 111 (7), 1293–1298. https://​doi.​org/​10.​1111/​add.​13341.

Khosla, S./Melton, L. J./Riggs, B. L. (2001). Estrogens and bone health in men. Calcified Tissue International 69 (4), 189–192. https://​doi.​org/​10.​1007/​s00223-001-1044-8.

Kubicová, Ľ./Kádeková, Z. (2016). Development and level of consumption of chosen foods in Slovakia and Austria, 777–782. https://​doi.​org/​10.​15414/​isd2016.​s10.​02.

Lee, J. J./Patel, R./Biermann, J. S./Dougherty, P. J. (2013). The Musculoskeletal Effects of Cigarette Smoking. Journal of Bone and Joint Surgery 95 (9), 850–859. https://​doi.​org/​10.​2106/​jbjs.​l.​00375.

Lips, P./Cashman, K. D./Lamberg-Allardt, C./Bischoff-Ferrari, H. A./Obermayer-Pietsch, B./Bianchi, M. L./Stepan, J./El-Hajj Fuleihan, G./Bouillon, R. (2019). Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society. European Journal of Endocrinology 180 (4), P23-P54. https://​doi.​org/​10.​1530/​EJE-18-0736.

Lohman, Timothy G./Roche, Alexander F./Martorell, Reynaldo (Eds.) (1988). Anthropometric standardization reference manual. Champaign, Illinois, Human Kinetics Books.

Maskell, P. D./Jones, A. W./Heymsfield, S. B./Shapses, S./Johnston, A. (2020). Total body water is the preferred method to use in forensic blood-alcohol calculations rather than ethanol’s volume of distribution. Forensic Science International 316, 110532. https://​doi.​org/​10.​1016/​j.​forsciint.​2020.​110532.

Maurel, D. B./Boisseau, N./Benhamou, C. L./Jaffre, C. (2012). Alcohol and bone: review of dose effects and mechanisms. Osteoporosis International 23 (1), 1–16. https://​doi.​org/​10.​1007/​s00198-011-1787-7.

Mertens, E./Kuijsten, A./Dofková, M./Mistura, L./D'Addezio, L./Turrini, A./Dubuisson, C./Favret, S./Havard, S./Trolle, E./Van't Veer, P./Geleijnse, J. M. (2019). Geographic and socioeconomic diversity of food and nutrient intakes: a comparison of four European countries. European Journal of Nutrition 58 (4), 1475–1493. https://​doi.​org/​10.​1007/​s00394-018-1673-6.

Mikosch, P. (2014). Alcohol and Bone. Wiener Medizinische Wochenschrift 164 (1-2), 15–24. https://​doi.​org/​10.​1007/​s10354-013-0258-5.

National Institute on Alcohol Abuse and Alcoholism (2024). What Is A Standard Drink? Alcohol's Effects on Health. Available online at https://​www.​niaaa.​nih.​gov/​alcohols-effects-health/​what-standard-drink (accessed 8/18/2025).

Natukunda, E./Szubert, A. J./Bamford, A./Doerholt, K./Gibb, D. M./Wandera, C./Nakalyango, A./Griffiths, A./Monkiewicz, L./Nangiya, J. J./Nambi, E./Musiime, V./Musoke, P. (2025). Comparison between dual energy X-ray absorptiometry and calcaneal quantitative ultrasound for determining bone mineral density in children living with HIV in uganda: A cross- sectional study. BMC Pediatrics 25 (1), 529. https://​doi.​org/​10.​1186/​s12887-025-05881-5.

Nicholson, W. K./Silverstein, M./Wong, J. B./Chelmow, D./Coker, T. R./Davis, E. M./Jaén, C. R./Krousel-Wood, M./Lee, S./Li, L./Mangione, C. M./Ogedegbe, G./Rao, G./Ruiz, J. M./Stevermer, J./Tsevat, J./Underwood, S. M./Wiehe, S. (2025). Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA 333 (6), 498–508. https://​doi.​org/​10.​1001/​jama.​2024.​27154.

Popova, S./Rehm, J./Patra, J./Zatonski, W. (2007). Comparing alcohol consumption in central and eastern Europe to other European countries. Alcohol and Alcoholism 42 (5), 465–473. https://​doi.​org/​10.​1093/​alcalc/​agl124.

Puranda, J. L./Edwards, C. M./Weber, V. M. R./Aboudlal, M./Semeniuk, K./Adamo, K. B. (2025). Validity of an ultrasound device to measure bone mineral density. Clinical Anatomy 38 (1), 54–62. https://​doi.​org/​10.​1002/​ca.​24187.

Ratajczak, A. E./Szymczak-Tomczak, A./Rychter, A. M./Zawada, A./Dobrowolska, A./Krela-Kaźmierczak, I. (2021). Impact of Cigarette Smoking on the Risk of Osteoporosis in Inflammatory Bowel Diseases. Journal of Clinical Medicine 10 (7), 1515. https://​doi.​org/​10.​3390/​jcm10071515.

Sampson, H. W./Perks, N./Champney, T. H./DeFee, B. (1996). Alcohol consumption inhibits bone growth and development in young actively growing rats. Alcoholism: Clinical and Experimental Research 20 (8), 1375–1384. https://​doi.​org/​10.​1111/​j.​1530-0277.​1996.​tb01137.​x.

Sebekova, K./Krivosikova, Z./Gajdos, M./Podracka, L. (2016). Vitamin D status in apparently healthy medication-free Slovaks: Association to blood pressure, body mass index, self-reported smoking status and physical activity. Bratislavske Lekarske Listy 117 (12), 702–709. https://​doi.​org/​10.​4149/​BLL_​2016_​135.

Shahbaz, Y./Shirmohammadi, R./Shamsghahfarokhi, S./Esfahani, H./Forghan, M./Eghbali Jelodar, H./Ashrafi, L./Mousavi, M. (2025). Inflammatory impact of cigarette smoking on bone function and structure; a review of evidence. Journal of Parathyroid Disease 13, e13302. https://​doi.​org/​10.​34172/​jpd.​2025.​13302.

Soyka, L. A./Fairfield, W. P./Klibanski, A. (2000). Clinical review 117: Hormonal determinants and disorders of peak bone mass in children. The Journal of Clinical Endocrinology and Metabolism 85 (11), 3951–3963. https://​doi.​org/​10.​1210/​jcem.​85.​11.​6994.

Sripanyakorn, S./Jugdaohsingh, R./Mander, A./Davidson, S. L./Thompson, R. P./Powell, J. J. (2009). Moderate ingestion of alcohol is associated with acute ethanol-induced suppression of circulating CTX in a PTH-independent fashion. Journal of Bone and Mineral Research 24 (8), 1380–1388. https://​doi.​org/​10.​1359/​jbmr.​090222.

Stefler, D./Pajak, A./Malyutina, S./Kubinova, R./Bobak, M./Brunner, E. J. (2016). Comparison of food and nutrient intakes between cohorts of the HAPIEE and Whitehall II studies. European Journal of Public Health 26 (4), 628–634. https://​doi.​org/​10.​1093/​eurpub/​ckv216.

Swinton, P. A./Elliott-Sale, K. J./Sale, C. (2023). Comparative analysis of bone outcomes between quantitative ultrasound and dual-energy x-ray absorptiometry from the UK Biobank cohort. Archives of Osteoporosis 18 (1), 77. https://​doi.​org/​10.​1007/​s11657-023-01287-x.

Taes, Y./Lapauw, B./Vanbillemont, G./Bogaert, V./Bacquer, D. de/Goemaere, S./Zmierczak, H./Kaufman, J.-M. (2010). Early smoking is associated with peak bone mass and prevalent fractures in young, healthy men. Journal of Bone and Mineral Research 25 (2), 379–387. https://​doi.​org/​10.​1359/​jbmr.​090809.

Tajaldeen, A./Alghamdi, S. S./Aljondi, R./Awan, Z./Helmi, N./Lingawi, K./Mujalad, A./Alzahrani, W. (2022). Associations between body mass index, body composition and bone density in young adults: Findings from Saudi cohort. Journal of Radiation Research and Applied Sciences 15 (1), 268–274. https://​doi.​org/​10.​1016/​j.​jrras.​2022.​03.​010.

Textor, J./van der Zander, B./Gilthorpe, M. S./Liskiewicz, M./Ellison, G. T. (2016). Robust causal inference using directed acyclic graphs: the R package 'dagitty'. International Journal of Epidemiology 45 (6), 1887–1894. https://​doi.​org/​10.​1093/​ije/​dyw341.

Tsao, H. M./Huang, M.-C./Liu, T.-H./Chang, H.-M./Chung, R.-H./Kuo, H.-W./Chen, A. C. H./Yang, R.-S./Liu, Y.-L. (2024). Association of bone turnover markers and craving reduction in patients with alcohol use disorder during withdrawal: Exploring the role of bone-brain axis. Alcohol, Clinical & Experimental Research 48 (12), 2294–2302. https://​doi.​org/​10.​1111/​acer.​15472.

Wang, Q./Nicholson, P. H. F./Timonen, J./Alen, M./Moilanen, P./Suominen, H./Cheng, S. (2008). Monitoring bone growth using quantitative ultrasound in comparison with DXA and pQCT. Journal of Clinical Densitometry 11 (2), 295–301. https://​doi.​org/​10.​1016/​j.​jocd.​2007.​10.​003.

Ward, K. D./Klesges, R. C. (2001). A meta-analysis of the effects of cigarette smoking on bone mineral density. Calcified Tissue International 68 (5), 259–270. https://​doi.​org/​10.​1007/​bf02390832.

Weng, W./Li, H./Zhu, S. (2022). An Overlooked Bone Metabolic Disorder: Cigarette Smoking-Induced Osteoporosis. Genes 13 (5), 806. https://​doi.​org/​10.​3390/​genes13050806.

WHO (2000). Obesity: preventing and managing the global epidemic. Available online at https://​pubmed.​ncbi.​nlm.​nih.​gov/​11234459/​.

WHO (2014). WHO STEPwise approach to surveillance (STEPS) 2014. Available online at https://​www.​who.​int/​publications/​m/​item/​standard-steps-instrument.

Xie, G./Huang, C./Jiang, S./Li, H./Gao, Y./Zhang, T./Zhang, Q./Volotovski, P./Rahmati, M./Li, Y. (2024). Smoking and osteoimmunology: Understanding the interplay between bone metabolism and immune homeostasis. Journal of Orthopaedic Translation 46, 33–45. https://​doi.​org/​10.​1016/​j.​jot.​2024.​04.​003.

Yoon, V./Maalouf, N. M./Sakhaee, K. (2012). The effects of smoking on bone metabolism. Osteoporosis International 23 (8), 2081–2092. https://​doi.​org/​10.​1007/​s00198-012-1940-y.

Zhang, W./Wang, X./Liu, Y./He, Q./Ding, Q./Mei, J./Li, X. (2024). Effects of exercise on bone mass and bone metabolism in adolescents: a systematic review and meta-analysis. Frontiers in Physiology 15, 1512822. https://​doi.​org/​10.​3389/​fphys.​2024.​1512822.

Downloads

Published

2026-03-03

How to Cite

Sulis, S., Falbová, D., Hozáková, A., & Vorobeľová, L. (2026). Association between alcohol consumption, smoking and bone tissue quality in Slovak young adults assessed by radial quantitative ultrasound . Human Biology and Public Health. https://doi.org/10.52905/hbph2026.112

Issue

Section

Articles