Health for life

Heavy drinking is a health risk for many reasons, including the effects on bones.

Research shows that chronic heavy alcohol use, especially during adolescence and young adult years, can dramatically affect bone health and increase the risk of osteoporosis later in life.

What do doctors advise? Drink less for strong bones.
 

Calcium is an essential nutrient for healthy bones, and alcohol is its enemy. "Alcohol has multiple effects on calcium," says Primal Kaur, MD, an osteoporosis specialist at Temple University Health System in Philadelphia. "The bones deteriorate because not enough calcium is getting into bones -- and the body is leaching it away from bones."

How Does Alcohol Harm Your Bones?

When you imbibe too much -- 2 to 3 ounces of alcohol every day -- the stomach does not absorb calcium adequately, Kaur explains. "Alcohol interferes with the pancreas and its absorption of calcium and vitamin D. Alcohol also affects the liver, which is important for activating vitamin D -- which is also important for calcium absorption."

The hormones important to bone health also go awry. Some studies suggest that alcohol decreases estrogen and can lead to irregular periods. As estrogen declines, bone remodeling slows and leads to bone loss. If youre in the menopausal years, this adds to the bone loss thats naturally occurring, says Kaur.

Theres an increase in two potentially bone-damaging hormones, cortisol and parathyroid hormone. High levels of cortisol seen in people with alcoholism can decrease bone formation and increase bone breakdown. Chronic alcohol consumption also increases parathyroid hormone, which leaches calcium from the bone, she says.

Also, excess alcohol kills osteoblasts, the bone-making cells, Kaur adds. To compound the problem, nutritional deficiencies from heavy drinking can lead to peripheral neuropathy -- nerve damage to hands and feet. And chronic alcohol abuse can affect balance, which can lead to falls, she explains.
Drinking and Your Risk of Fracture

Heavy drinkers are more likely to suffer frequent fractures due to brittle bones and nerve damage, especially hip and spine fractures, Kaur says. Those fractures will likely heal slowly because of malnutrition.

When you quit drinking, your bones may recover fairly rapidly. Some studies have found that lost bone can be partially restored when alcohol abuse ends.

If youre a smoker, its important that you quit that habit, too. "If you are a heavy drinker who also smokes, it makes your bone problems even worse," Kaur tells . "You need to quit both habits, or osteoporosis treatment is not going to work." In fact, studies suggest that quitting smoking helps people recover from alcoholism.
Drink Less for Strong Bones

Summer barbecues, family get-togethers, after-work happy hours -- theyre full of temptations. Everyones drinking, having a good time. If youre used to imbibing, its hard to say no. But if youre goal is strong bones, these tips will help you drink less.

"Its difficult to deny yourself," says Murray Dabby, LCSW, director of the Atlanta Center for Social Therapy. "Theore, you have to find something to say yes to. ... Thats the more winning strategy."

Saying yes to healthy living is a good first step, "Take the focus off not drinking or not smoking."

As a coach and therapist, he asks people to understand their relationship to alcohol. "That relationship says a lot about how you see yourself -- Im socially awkward, Im shy, Im anxious, Im insecure, and alcohol makes me feel more comfortable."

To overcome shyness sans alcohol, heres his suggestion: "As Shakespeare would say, Life is a stage. Create a new performance for yourself. Act like the person you want to be," Dabby says.

If parties make you self-conscious, heres a positive approach: Act like youre the co-host. "Focus on making people comfortable rather than worrying about yourself," he explains. "Go around greeting everyone, asking how they know the host. Perform as if youre the friendliest person at the party. You wont need alcohol to cover up your nervousness."

Another tactic: Pretend that youre tipsy. If you love going to karaoke bars but cant enjoy it without alcohol, simply pretend, Dabby suggests. "Order ginger ale, but act like youre tipsy." Thats the approach that one person took,  "It was very successful for him. He found he could ham it up without alcohol."

If after-work happy hours are a problem, dont focus on drinking: "Focus on getting to know your co-workers. Be curious, ask questions. Focus on relationship-building, because thats a positive thing,” Dabby says. “Order ginger ale or another nonalcoholic drink. You dont have to tell anyone you have trouble with alcohol."

If you lead a horse to water, will it drink?  If it drinks, does that cause it to be a horse?  Who says being a horse is good? Do horses cure thirst?

Those were the silly Disease Management Care Blog questions prompted by a paper trail of articles and letters about the Patient Centered Medical Home (PCMH) that recently appeared in the Archives of Internal Medicine.  That being said, the series was a telling example of the assumptions underlying PCMH research and the lack of of buy-in from community-based physicians

To wit:

Primary Care Is Good: The first article was this October 2011 published research that retrospectively mined the Surveillance, Epidemiology and End-Result (SEER)-Medicare-linked database.  The authors found that for Medicare fee-for-service beneficiaries aged 67 to 85 years, more colorectal cancer screening, earlier cancer diagnosis and lower cancer mortality were all associated with an increased number of past primary care visits. While the study could not rule out the possibility that other factors were involved in the association between primary care and cancer screening (Katy Courics campaign, for example, could have prompted patients to see their PCPs), this study indicated that that access to primary care is a good thing.

If Primary Care Is Good, So Is The Patient Centered Medical Home: The second article was this "Decisive Moment" editorial appearing in the same issue of the Archives, authored by Boston academics Asaf Bitton and Joseph Frolkis.  They reviewed the SEER article, which never even mentioned the PCMH.  That didnt stop the editorialists from bringing it up in an opening paragraph as an "innovative model of care delivery." The article then went on to describe the virtues of generic primary care and the need to increase PCPs in the physician workforce. It then saluted the PCMH as "offer[ing] promising early results [with] a pathway to weld some of the best incremental practice change initiatives onto a chassis of sustainable, term based care."

Who Says the PCMH Is So Good? The third was this Editors Correspondence letter that appeared six months later in the March 26 2012 issue of the Archives. Arguing that many PCPs already provide medical home-like services, private practitioner Edward Volpintesta of Connecticut didnt share Drs. Bitton and Frolkis "optimism" over the PCMH  He observed that 100% of any additional fees generated by the PCMH would have to go toward funding its excess costs and never go toward rewarding the physician.

We Say Its Good: Drs Bitton and Frolkis disagreed in a Editors Correspondence reply. Depending on your definition of a medical home, they argued that most PCPs do not offer that kind of care and that their research shows that the added income from the PCMH can be considerable. 

While the article-editorial-correspondence virtual paper trail is a classic exercise in academic repartee filled with the usual medical jargon, tangential policy nostrums, assumptions and quoting the literature out of context, the real lesson here is that there is some real skepticism about the PCMH among otherwise seasoned primary care physicians. While the mainstream peer-reviewed medical journals have articles that are extrapolating the virtues of primary care onto the PCMH, docs like Dr. Volpintesta arent necessarily buying it.

To the DMCB, this spells significant challenges for the dissemination of the medical home outside the academic community and their early adopter allies. 

Some mainstream doctors remain unconvinced.