A NATIONWIDE South Korean cohort study has revealed that alcohol consumption is linked to a graded rise in incident osteoarthritis risk, independent of liver function and body weight.
Osteoarthritis has become a leading cause of chronic pain and disability in ageing populations, and cases continue to rise. Alcohol consumption is a modifiable behaviour linked to many health outcomes, yet its association with incident osteoarthritis has remained unclear.
Researchers analysed South Korean National Health Insurance Service data for adults aged 40 years and older, screened in 2009 to 2011 with no baseline osteoarthritis. Self-reported drinking frequency and daily ethanol intake classified participants as light, moderate, or heavy drinkers, with sex-specific thresholds (men: <10, 10 to <30, ≥30 g/day; women: <10, 10 to <20, ≥20 g/day). Follow-up continued until incident osteoarthritis diagnosis (ICD-10 M15 to M19, excluding trauma), death, or December 2023. Of 2,197,872 adults, 1,233,179 had estimable intake, with a mean age of 50.8 years and 9.9 years’ follow-up.
Among the 1,233,179 participants, 571,077 incident osteoarthritis cases occurred during follow-up. Compared with non-drinkers, heavy drinkers had 18.6% higher risk of incident osteoarthritis. In particular, adjusted hazard ratios for incident osteoarthritis were 1.037 (95% CI: 1.030 to 1.045) for light drinkers, 1.081 (95% CI: 1.072 to 1.091) for moderate drinkers, and 1.186 (95% CI: 1.174 to 1.197) for heavy drinkers. Similarly, a clear dose-response pattern was also seen for drinking frequency.
The association remained robust after adjustment for a broad range of demographic, behavioral, and metabolic factors and persisted in prespecified normal liver function and normal weight cohorts, suggesting that this association is unlikely to be explained solely by hepatic dysfunction or obesity.
The data also suggested that the association between alcohol consumption and osteoarthritis risk differs by sex. Men in the light-drinking group demonstrated a null-to-slightly inverse association (adjusted HR: 0.990; 95% CI: 0.978 to 1.001), whereas women in the light-drinking group showed an increased risk (adjusted HR: 1.063; 95% CI: 1.053 to 1.073). The authors highlighted that this sex difference may warrant further investigation, and may reflect residual confounding, exposure misclassification, or context-specific social drinking behaviors.
These findings have identified alcohol consumption as a graded, dose-dependent risk factor for incident osteoarthritis that has persisted after accounting for liver function and body weight. Causal inference cannot be drawn from observational data, but the consistency across analyses strengthens the case for a genuine link. Clinicians may wish to consider alcohol intake when counselling patients on joint health, particularly women, who appear susceptible at lower consumption levels.
Reference
Cho S et al. Alcohol consumption and incident osteoarthritis: a nationwide population-based longitudinal study. Osteoarthritis and Cartilage. 2026;DOI:10.1016/j.joca.2026.09.005.
Featured image: Africa Studio on Adobe Stock
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
