{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T05:49:44Z","timestamp":1776232184097,"version":"3.50.1"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Health Labor Sciences Research Grant, Ministry of Health Labor and Welfare, Japan","award":["H21-NANCHI-IPPAN-168"],"award-info":[{"award-number":["H21-NANCHI-IPPAN-168"]}]},{"name":"Health Labor Sciences Research Grant, Ministry of Health Labor and Welfare, Japan","award":["H24-NANCHITOU(NAN)-IPPAN-001"],"award-info":[{"award-number":["H24-NANCHITOU(NAN)-IPPAN-001"]}]},{"name":"Health Labor Sciences Research Grant, Ministry of Health Labor and Welfare, Japan","award":["H26-NANCHITOU(NAN)-IPPAN-059"],"award-info":[{"award-number":["H26-NANCHITOU(NAN)-IPPAN-059"]}]},{"name":"Health Labor Sciences Research Grant, Ministry of Health Labor and Welfare, Japan","award":["H29-NANCHITOU(NAN)- IPPAN-053"],"award-info":[{"award-number":["H29-NANCHITOU(NAN)- IPPAN-053"]}]},{"name":"Health Labor Sciences Research Grant, Ministry of Health Labor and Welfare, Japan","award":["20FC1010"],"award-info":[{"award-number":["20FC1010"]}]},{"name":"Health Labor Sciences Research Grant, Ministry of Health Labor and Welfare, Japan","award":["23FC1045"],"award-info":[{"award-number":["23FC1045"]}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["25K19962"],"award-info":[{"award-number":["25K19962"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Practical Research Project for Rare\/Intractable Diseases from the Japan Agency for Medical Research and Development"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Alcohol consumption is a recognized risk factor for osteonecrosis of the femoral head (ONFH), as well as hypertension, and malignant tumors. Aldehyde dehydrogenase 2 (ALDH2) activity influences alcohol-associated risks by modulating acetaldehyde metabolism; however, its role in ONFH remains unclear. This study aimed to investigate whether the alcohol flushing response, a proxy for ALDH2, modifies the relationship between alcohol consumption and ONFH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A hospital-based case\u2013control study was conducted on newly diagnosed patients with ONFH and controls recruited. Information on alcohol flushing responses was collected using a self-administered questionnaire and categorized into current\/former flushers (inactive ALDH2) and never flushers (active ALDH2). Odds ratios (OR) and their 95% confidence intervals (CI) of various levels of alcohol consumption (habitual drinking, heavy drinking, and drinking of \u2265320\u00a0g\/week) were assessed for ONFH using a logistic regression model. Stratified analysis and multiplicative interaction were used to investigate the effect modification by the alcohol flushing response on the association between alcohol consumption and ONFH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 118 cases with ONFH and 213 controls were included (mean age, 45\u00a0years; 197 men and 134 women). The adjusted ORs of alcohol consumption for the development of ONFH were 1.5 (95% CI: 0.4\u20136.0) and 3.7 (0.3\u201341.3) for habitual drinking, 1.6 (0.4\u20135.6) and 2.0 (0.1\u201324.2) for heavy drinking, and 3.8 (0.8\u201317.6) and 4.5 (0.4\u201349.2) for drinking of \u2265320\u00a0g\/week among current\/former and never flushers, respectively. No significant multiplicative interactions were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Alcohol flushing response may not modify the relationship between alcohol consumption and the risk of ONFH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/mr\/roaf107","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T13:20:02Z","timestamp":1762435202000},"page":"476-482","source":"Crossref","is-referenced-by-count":0,"title":["Does the alcohol flushing response modify the relationship between alcohol consumption and the risk of developing osteonecrosis of the femoral head? A multicenter case\u2013control study in Japan"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7855-8037","authenticated-orcid":false,"given":"Tetsuro","family":"Tani","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine , Osaka ,","place":["Japan"]},{"name":"Department of Orthopaedics and Rehabilitation Medicine, Unit of Surgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui , Fukui ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9352-465X","authenticated-orcid":false,"given":"Wataru","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kansai Rosai Hospital , Amagasaki ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3666-6942","authenticated-orcid":false,"given":"Wakaba","family":"Fukushima","sequence":"additional","affiliation":[{"name":"Department of Public Health, Osaka Metropolitan University Graduate School of Medicine , Osaka ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3652-9400","authenticated-orcid":false,"given":"Hidetoshi","family":"Hamada","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine , Osaka ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Takao","sequence":"additional","affiliation":[{"name":"Department of Bone and Joint Surgery, Ehime University Graduate School of Medicine , Toon-city ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6187-4957","authenticated-orcid":false,"given":"Takuaki","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Fukuoka University Graduate School of Medicine , Fukuoka ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Sakai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine , Yamaguchi ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5305-3179","authenticated-orcid":false,"given":"Nobuhiko","family":"Sugano","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine , Osaka ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"2026041500565533000_ref1","doi-asserted-by":"publisher","first-page":"73???78","DOI":"10.1097\/00003086-199204000-00009","article-title":"The fate of nontraumatic avascular necrosis of the femoral head. 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A multicentre study","volume":"81","author":"Sugano","year":"1999","journal-title":"J Bone Joint Surg Br"},{"key":"2026041500565533000_ref25","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.1007\/s00264-018-3897-8","article-title":"Quality of life of patients with osteonecrosis of the femoral head: A multicentre study","volume":"42","author":"Uesugi","year":"2018","journal-title":"Int Orthop"},{"key":"2026041500565533000_ref26","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1007\/s00776-012-0293-x","article-title":"Pronounced risk of nontraumatic osteonecrosis of the femoral head among cigarette smokers who have never used oral corticosteroids: A multicenter case-control study in Japan","volume":"17","author":"Takahashi","year":"2012","journal-title":"J Orthop Sci"},{"key":"2026041500565533000_ref27","doi-asserted-by":"publisher","DOI":"10.1111\/jch.14928","article-title":"Alcohol consumption in adolescence on early-adulthood hypertension or prehypertension","volume":"26","author":"Hayibor","year":"2024","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"2026041500565533000_ref28","first-page":"2447","article-title":"Microvascular and vascular smooth muscle actions of ethanol, acetaldehyde, and acetate","volume":"41","author":"Altura","year":"1982","journal-title":"Fed Proc"},{"key":"2026041500565533000_ref29","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/S0022-3565(25)22707-0","article-title":"Acute and chronic effects of ethanol and its metabolites on vascular production of prostacyclin in rats","volume":"240","author":"Guivernau","year":"1987","journal-title":"J Pharmacol Exp Ther"},{"key":"2026041500565533000_ref30","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1016\/0091-3057(90)90181-G","article-title":"Possible involvement of kinins in cardiovascular changes after alcohol intake","volume":"35","author":"Hatake","year":"1990","journal-title":"Pharmacol Biochem Behav"},{"key":"2026041500565533000_ref31","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1093\/rheumatology\/ken206","article-title":"Non-traumatic necrosis of bone (osteonecrosis) is associated with endothelial cell activation but not thrombophilia","volume":"47","author":"S\u00e9guin","year":"2008","journal-title":"Rheumatology (Oxford)"},{"key":"2026041500565533000_ref32","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.jsbmb.2009.02.007","article-title":"Glucocorticoids in osteonecrosis of the femoral head: A new understanding of the mechanisms of action","volume":"114","author":"Kerachian","year":"2009","journal-title":"J Steroid Biochem Mol Biol"},{"key":"2026041500565533000_ref33","doi-asserted-by":"publisher","first-page":"121","DOI":"10.2739\/kurumemedj.50.121","article-title":"A case-control study of association between life-style, alcohol dehydrogenase 2 and aldehyde dehydrogenase 2 genotype and idiopathic osteonecrosis of the femoral head","volume":"50","author":"Sakata","year":"2003","journal-title":"Kurume Med J"},{"key":"2026041500565533000_ref34","doi-asserted-by":"publisher","first-page":"37","DOI":"10.2188\/jea.6.37","article-title":"Flushing pattern and idiopathic avascular necrosis of the femoral head","volume":"6","author":"Shibata","year":"1996","journal-title":"J Epidemiol"},{"key":"2026041500565533000_ref35","author":"Ministry of Health, Labour and Welfare. National Health and Nutrition Survey 1994. Tokyo, Japan: Ministry of Health, Labour and Welfare; 1994."},{"key":"2026041500565533000_ref36","author":"Ministry of Health, Labour and Welfare. National Health and Nutrition Survey 2016. Tokyo, Japan: Ministry of Health, Labour and Welfare; 2016."},{"key":"2026041500565533000_ref37","doi-asserted-by":"crossref","first-page":"15035","DOI":"10.1038\/s41598-017-14778-y","article-title":"Genome-wide association study of idiopathic osteonecrosis of the femoral head","volume":"7","author":"Sakamoto","year":"2017","journal-title":"Sci Rep"},{"key":"2026041500565533000_ref38","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1002\/cncr.22795","article-title":"Susceptibility to lung cancer and genetic polymorphisms in the alcohol metabolite-related enzymes alcohol dehydrogenase 3, aldehyde dehydrogenase 2, and cytochrome P450 2E1 in the Japanese population","volume":"110","author":"Minegishi","year":"2007","journal-title":"Cancer."}],"container-title":["Modern Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/mr\/advance-article-pdf\/doi\/10.1093\/mr\/roaf107\/65240884\/roaf107.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mr\/article-pdf\/36\/3\/476\/65240884\/roaf107.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mr\/article-pdf\/36\/3\/476\/65240884\/roaf107.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T04:57:03Z","timestamp":1776229023000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mr\/article\/36\/3\/476\/8316756"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,7]]},"references-count":38,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,11,7]]},"published-print":{"date-parts":[[2026,4,13]]}},"URL":"https:\/\/doi.org\/10.1093\/mr\/roaf107","relation":{},"ISSN":["1439-7595","1439-7609"],"issn-type":[{"value":"1439-7595","type":"print"},{"value":"1439-7609","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2025,11,7]]}}}