IntroductionAlcoholism may damage the skeleton. In addition to a direct effect of ethanol, many other mechanisms are involved which should be considered in the clinical evaluation of alcoholic patients. We will review the mechanism and clinical consequences of bone alterations observed in alcoholics. ConclusionOsteoporosis is the main metabolic disease observed in alcoholic patients. The main factors involved in its pathogenesis are: a direct effect of ethanol, associated malnutrition, liver disease, altered hormone profile and cytokine pattern, and alcoholic myopathy. Osteoporosis may lead to bone fracture. It improves with ethanol withdrawal.