Osteoporosis, alcohol and smoking

Together with having a balanced diet and regular exercise other lifestyle behaviours, such as drinking alcohol in moderation and not smoking, are vital for good osteoporosis management and for overall good health. Drinking alcohol in quantities that exceed the recommended daily units and smoking tobacco are both considered risk factors for osteoporosis.

Men and women are advised not to drink more than 14 units a week on a regular basis (NHS choices June 2017). Michelle thinks that the weekly units of alcohol for women is still high but many of the people we talked to said that they drink ‘very little’ or ‘in moderation’ and certainly much less than the recommended amount. One reason given was that too much alcohol is likely to be dangerous because a drunken person is more prone to fall and fracture or as Clare put ‘it is asking for trouble’. Many people said that they may drank a glass of wine or two over dinner, or when socialising with friends, but not every day.

The only alcoholic drink that Susannah drinks these days is in a cold/flu mixture she prepares.

Age at interview 76

Gender Female

Age at diagnosis 47

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Do you drink alcohol?

No. There was a time when I was drinking, taking a glass of red wine a day because that’s supposed to be good. I have got alcohol in the house and I’ve got a wonderful cure if you get flu or very cold. I think, I don’t know if it wasn’t a Russian one. Fortunately I haven’t got the full details but its garlic in vodka. You put garlic in vodka. I don’t know how long you’re supposed to keep it for or what but I have that. If I ever come in freezing cold and I take that I don’t have a cold. I mean it’s better than a flu injection. So I include garlic in my diet and ginger.

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Another reason given for drinking small amounts of alcohol or for being teetotal is medication. Several people were taking pain medication which interacted with alcohol and therefore they had been advised to avoid alcohol. Robert for instance is on OxyContin oral. Others were taking medication for other conditions such as rheumatoid arthritis and depression.
Whilst having to give up drinking alcohol per se was not seen as a problem it could however, have an effect on lifestyle. Robert, who is in his forties, doesn’t drink any alcohol and no longer felt he has the energy to go out to bars or pubs with his friends. David, who is in his thirties, on the other hand, has a busy social life but said that he doesn’t necessarily drink alcohol every time he goes out with friends (see also Osteoporosis, social life, leisure and holidays).

David drinks occasionally and in moderation.

Age at interview 25

Gender Male

Age at diagnosis 23

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Do you drink alcohol? How much do you drink?

A little bit. But not, not a terrible amount no. Maybe at Christmas [laughs]. Yeah, I do have a bit and but you know within limits and there probably are medications that I shouldn’t be drinking with but you know I don’t go crazy and not every, you know probably once a week, maybe once every two weeks. I mean if I go out I don’t necessarily drink you know, I mean I might go out a lot, but I don’t necessarily drink so I can still drive. You know and obviously when I do drink I don’t drive, I get a taxi in that circumstance. But yeah I mean if I go out I mean just wanna have a good time really, and that doesn’t always involve alcohol and don’t smoke, and so yeah I mean, I do in moderation, I admit that but you know my Doctor does know that.

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Some men said that they used to drink more when they were younger. Sydney made the point that in comparison to the youngsters of today his peer group drank in ‘moderation’. Nowadays he goes once a week to meet his ex-work colleagues and have a beer.
Several of the people we talked to said that they may drink more than the recommended units per week.

For Valerie drinking alcohol is a question of quality rather than quantity.

Age at interview 67

Gender Female

Age at diagnosis 63

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What about drinking alcohol?

Yes I drink. I smoke, yes. I have, I to some extent I binge drink but I, normally I drink with meals. I drink less than I used to at the moment. But as I say I lived in France and I would say that I drank normally. You often have a four or five hour dinner several times a week and when you’re having a four or five hour dinner you probably drink a bottle of wine. But I, I now drink with my neighbours more frequently but that tends to be without a meal. So I mean I try to eat before I go there or drink some milk. So I still drink most weeks. Yes.

How many units would you say per week?

Well I would say it’s more than they tell you, you can. Yeah. I mean I’m not very clear about this but I. One thing I notice before they started mentioning it in the papers because I do know a little bit about wine and I noticed the big glasses they give you in a pub they’re usually the colonial wines, and they are 14º or more, very frequently and I found before I drunk more than a few sips I had a headache. So now I look as if I’m being quite precious when I go into pubs and restaurants because I want to see the label. I want to see if possible that it’s no more than 12½. I would prefer it to be more than a year old and I do not drink wine that comes from what one could call the ex colonies. I drink European wine.

And I don’t usually drink white, I drink red wine. I don’t generally drink red wine from Spain unless it’s a very good vintage.

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Keith occasionally drinks more than the recommended units but he doesnt binge drink.

Age at interview 55

Gender Male

Age at diagnosis 54

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What about drinking alcohol?

I probably, I mean I don’t binge drink for a start, I do like my, I do like my wine, and I probably struggle to stay within the 21 units. I mean I’ll occasionally just a little drink, and I top them up and I’m probably more like about 23 a week, so I’m probably just a little bit over, but you know not, not hugely over, and, I’m frankly I mean, I know that is very little, I mean, those you know those guideline limits were based on very little evidence anyway, it was just basically guess I think by the BMA. So you know I’m not too worried about that, and as I say I don’t, you know I don’t binge drink.

And do you smoke?

I don’t smoke. Never smoked.

Okay.

So as a matter of fact and on the Canadian website that’s one of the things that you could actually put in, the you know, basically your drinking habits as well, you know and I, you know I put my alcohol you know, my estimate 24 units or whatever it was in into the website and it got some tiny increase in the risk I think, but it was pretty low, so obviously I’m not, you know I’m not a heavy enough drinker for it to seriously affect my risk of osteoporosis.

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Most people we talked to did not smoke. Many have never smoked and others have ‘packed it up’ decades or several years ago for a variety of reasons including doctor’s advice, chest pain, heart attack and cost. Several of those who had smoked in the past had been heavy smokers but stressed that they had not found it difficult to quit the habit even though some smoked forty or sixty cigarettes a day. Sydney used to be a heavy smoker but stopped forty years ago. Dennis used to smoke sixty a day and gave it up from one day to the next. Laurence took medication to help him stop smoking but like Sheila he thinks that willpower is more important. And Iris said that she ‘swapped the cigarettes for a mortgage and bought a house instead’. All of them felt proud to have mastered their addiction.

Sheila stopped smoking immediately when she had a heart attack.

Age at interview 71

Gender Female

Age at diagnosis 66

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I used to smoke. I gave it up four years ago.

Were you how many roughly did you smoke?

I used to smoke, what 20 a day I suppose.

Ok.

Yeah.

Do you drink alcohol?

No I don’t drink.

Ok.

No. I used to have the odd drink when we used to go on holiday but of course now since I’ve had my heart attack I don’t drink. I drink juices. I don’t drink any alcohol at all.

Any particular reason why you gave up smoking?

Yeah because of my heart attack.

Because of your heart?

Yeah.

Ok.

They advised me, you know, not to smoke again. They said it was through smoking what caused my heart attack. So this is why I gave it up. Well I gave it up straight away. I didn’t think about it. I just gave it up like that.

I didn’t take any medication or patches, tablets or anything. I just gave it up.

That must be. Fear was the best therapy in your case?

Yeah [laugh].

That’s a good one.

Yes. Yeah because you know some people you talk to they find it so difficult to give up you know. And I think to myself its mind over matter really because I said to myself when I was in hospital, I’m not going to touch another cigarette. You know that nearly killed me and I’m not going to touch another one. And the thought, the smell of one now it, it makes me feel sick. And I don’t, I’ve never touched one since. No never.

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Laurence gave up smoking ten years ago on his doctors advice.

Age at interview 62

Gender Male

Age at diagnosis 54

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It all come comes down to will power, self-control doesn’t it. I mean it’s like regards to smoking Oh, I can’t give up smoking, have a fag. I used to smoke cigarettes and I’ve never I went… I had pleurisy and gastric flu and I went and the doctor said to me, How many cigarettes do you smoke, Lawrence?’ And I said, About ten a day. Oh You’ll be dead by the time you’re twenty five. He said to me.

I used to sort of roll me own and went playing bowls we had an inter-departmental bowls match once in [pause 5 seconds] on the telly they had this programme about this bloke will all his lungs in it and he [doctor] mentioned it, That could be yours, Laurence. He said. So I’ve put me fag down, stubbed it out, you know and, used to smoke cigars and. Our dad used to smoke cigarettes and he was [coughs] and I think, Well, that’s supposed to be pleasure. You know, I always said I’d pack up smoking cigars if I had a cough like him but I did inhale see, you’re not supposed to inhale a cigar which I did do and I started getting pains in me chest so I thought, Sod this. So I packed in.

So you gave up?

Give up.

How long ago? Long time ago.

About yeah about ten year ago I expect.

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Beryl continues smoking but would very much like to give it up but every attempt she has tried until now has failed. She tried acupuncture but she managed to stop smoking for two weeks before taking it up again. She knows that her lungs are damaged and she needs to use oxygen everyday to help her cope with her breathing difficulties. She said that her doctors have insisted on her giving it up but to no avail. Pat who continued smoking about five a day said that she has received no advice or information on smoking from health professionals. Valerie has cut down the number of cigarettes she smokes per week but has no intention of giving up her cigarettes.

Beryl has been trying to stop smoking for 20 years, but nothing has worked long term.

Age at interview 72

Gender Female

Age at diagnosis 69

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You have been smoking since when?

Yeah since I was about 16. I only smoke about eight a day now. But I do want to pack up altogether [cough].

You used to smoke more than eight before?

I probably did, probably about 10 or might even have been 15. I went for an acupuncture, I’ve had acupuncture done three times. The second time I didn’t smoke for a whole, nearly a fortnight. I didn’t even fancy one and I thought lovely, I’ve cracked it. And then all of a sudden I was gasping for one and I thought well one won’t hurt. That was the start.

So you would like to stop?

Oh I would give anyone £1000 if they’d get me to, could help me to stop.

I’ve been twice to the meetings they used to have, you know, the National Health got it up and I’ve had patches. I even had that last one that a lot of people, made them ill. Well it, they didn’t agree with me either. But I really would. You know the specialist said I’ve got to pack up so I’ve got to pack up [laugh].

So for how long have you been trying to give up?

Really the, about twenty odd years I’ve been trying, [pause] twenty odd years I’ve been trying to pack up.

But do you think that the smoking damaged your bones?

Personally no. I mean I’m not an expert so I don’t know but I think a lot of pills and tablets don’t do you any good. You, I think you can take too many of them.

In medications you mean?

Yeah. And most of the antibiotics I’ve been in the last few years haven’t agreed with me anyway, give me side effects.

So just last question about smoking why do you want to give up smoking? Why have you been trying for the last 20 years?

Well two reasons. The main one is my health and the second one is the cost.

So you know that smoking is damaging your health?

Yeah. I, I don’t believe a lot of that, what they say but I, it probably does do a lot of harm. I mean the people that come up to me, you know, and I’ve said I’m trying to pack up. They said, Oh my sister died of cancer and she’s never smoke. And most of the people I know that’s got breast cancer they’ve never smoked. So [ah] but I, I agree that it doesn’t do you any good.

And I would like to pack up and I think if I’d have packed up when I first tried to pack up what would my health be like now?

And now you need, you need to use oxygen every day?

Most evenings yeah, every evening I don’t go to bed without being on it for half an hour.

And what has the doctor said about your lungs, the condition of your lungs?

Well he said if I don’t pack up. You would think I’d, at least with, make me stop. it’s what I’ve had a go at myself about. And he said, it’s going to be terrible for you. You won’t be able to swallow, you won’t be able to do nothing. it’s terrible He said, You must pack u. And he said, I went last week over to [hospital] and he was, he said, You’ve got to pack u.

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Valerie has smoked since she was in her early twenties and had no idea that smoking could be a…

Age at interview 67

Gender Female

Age at diagnosis 63

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Well I tried. I cut it down a little bit but I’m not really motivated to stop smoking. Occasionally I think about it but I have rationed myself. I, for probably since my early 20s I had smoked 20 a day. I have cut it down in the last few years and I have a ration of five a week, five packets a week, not cigarettes. So if I’m working I can’t smoke. I smoke more when I’m not working as you can’t smoke in workplaces and things. Years ago I worked in a place where you couldn’t smoke. I ended, actually ended up smoking two packets a day because I couldn’t smoke at work. So forbidding you smoking at work it doesn’t necessarily cut down the amount, like the wine this may sound very odd to people who are very anti-smoking but I smoke the cigarettes which have a very high tobacco content and they haven’t got so many chemicals to keep the tobacco burning as the lower ones. I just think that there’s more chemicals in the lighter ones and anyway you smoke more of them so you smoke more chemicals because you’re going to smoke more of them because there’s not enough in them anyway.

No I had no idea that it could. I mean I was perfectly aware, and my mother was aware in her 20s of the fact that it causes cancer and everything. That’s never stopped anybody from smoking in fact. But I didn’t, never heard about osteoporosis or anything of that kind.

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In fact, several people had given up smoking tobacco and drinking alcohol due to lifestyle changes and/or ill health.

Gloria gave up drinking alcohol and smoking thirty years ago when she became ill with kidney…

Age at interview 66

Gender Female

Age at diagnosis 58

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No, I haven’t drunk alcohol for thirty I think it’s probably about thirty four years.

Why was that?

Well because I had kidney stones and when I was first diagnosed with kidney stones the consultant said not to drink alcohol, so I just stopped drinking it. I mean I only drank it socially anyway but he said don’t drink it so I just stopped. And I haven’t drunk since.

What about smoking?

I gave up smoking also thirty odd years ago after my second operation. I had an operation on one kidney to have the kidney stones removed and I couldn’t smoke in hospital but I had this awful cough and the physiotherapist used to come do physiotherapy on me and she said, it’s the smoking. I thought, I won’t smoke. But as soon as I came out of hospital I started smoking again. Really regretted it and then less than a year later I had to have an operation on my other kidney for kidney stones and I was, by this time I was feeling so ill I thought if I stop smoking before I go into hospital it might help. So I just gave up smoking then and I’ve never smoked since.

And how long ago was this?

It must have been probably about thirty four years ago.

Okay. So were you a heavy smoker?

I smoked twenty a day at least, yeah.

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Osteoporosis and exercise

It is important to bear in mind that the correct drug treatment, a calcium-rich diet and weight bearing exercises can all increase bone mass (...