To assess the relationship between the osteonecrosis of the femoral head (ONFH) and the patterns of alcohol intake and evaluate the risk factors associated with alcohol-induced ONFH using an epidemiologic study.

The study examined 250 patients (333 hips) with ONFH, who were diagnosed based on the findings after a total hip arthroplasty. Among them, 169 patients who were not associated with the specific etiologic factors except for a history of alcohol were selected in the case group. These patients were compared with the 338 controls, which were matched for gender, age, occupation and education. The patterns of alcohol intake, cigarette smoking, the level of the liver function test and body mass index were statistically assessed in relation to the development of ONFH.

The incidence of alcohol-induced ONFH was 42.8% in all ONFH patients. The average duration of alcohol ingestion was 8.1 years. The average quantity of alcohol per day, per week and drink-years were 84.8 g, 328.6 g and 4, 330 respectively. The elevated relative odds were observed for 1) frequent drinkers (>4/week), 2) the amount of intake per day >90 g, 3) the amount of alcohol intake per week >300 g, 4)drink-year >6, 000, 5) the patients had not consumed food with their drinks. A increased risk was found for smokers (>20 cigarettes/day), patients with an increased serum transaminase level and body mass index < or =25.

Chronic alcohol intake showed significant dose-response relation in the development of ONFH. The Increased amount of alcohol per day was a more significant risk factor than the total duration of alcohol intake. The pattern of alcohol consumption is one of the risk factors associated with the development of alcohol induced ONFH.