Association of bone turnover markers and craving reduction in patients with alcohol use disorder during withdrawal: Exploring the role of bone‐brain axis

Abstract Background Alcohol use disorder (AUD) is associated with imbalanced bone turnover and psychological symptoms, but the relationship between bone and brain remains unclear. The study analyzed serum levels of a bone formation marker, procollagen type 1 N‐terminal propeptide (P1NP), and bone resorption marker, C‐terminal telopeptide of type I collagen (CTX‐1), in AUD patients before and after 2 weeks of alcohol withdrawal and investigated their correlation with psychological symptoms. Methods Ninety patients with AUD and 117 healthy controls were recruited. P1NP and CTX‐1 levels were measured using Enzyme‐Linked Immunosorbent Assay. The Penn Alcohol Craving Scale (PACS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were assessed in the AUD group at baseline, week 1, and week 2 of withdrawal. Results Baseline CTX‐1 levels, along with the CTX‐1/P1NP and P1NP/CTX‐1 ratio, were higher in the AUD group than controls. Over the 2‐week withdrawal, PACS, BDI, and BAI scores demonstrated significant reductions. P1NP ( p < 0.001) and P1NP/CTX‐1 ratio increased ( p < 0.001), while CTX‐1/P1NP ratio decreased ( p < 0.001), indicating a propensity toward bone formation. Univariate analysis revealed that reductions in PACS, BDI, and BAI scores during withdrawal correlated with increased P1NP levels and decreased CTX‐1/P1NP ratios. However, multivariate analysis indicated that only PACS score reductions correlated with these changes. Conclusions Bone metabolism shifted toward increased bone formation and decreased bone resorption during 2‐week alcohol withdrawal. The correlation between improvements in bone turnover markers and reduction in craving scores during withdrawal supports the concept of the bone‐brain axis.