It is well documented that alcohol abuse is associated with an increased risk of fracture in men, but the relationship of moderate alcohol intake to bone mineral density (BMD) is not as clear. We examined the relationship between self-reported alcohol intake and BMD measured at the hip and spine using dual X-ray absorptiometry in a population-based cohort of men. The men were categorized as (1) non-drinkers and drinkers and (2) as having no, low, medium, and high alcohol intake (units/week). 458 men aged 69.1 +/- (SD) 2.8 (range 64-76) years were studied. Drinkers were significantly younger (p = 0.01), had lower recorded caffeine intake (p = 0.02), and had fewer pack years of smoking (p = 0.04) than non-drinkers. The mean BMD at the hip was significantly higher in drinkers as compared with non-drinkers (p = 0.02) before and after adjusting for age and weight. However, after further adjusting for pack years of smoking, caffeine intake, and physical activity, the difference remained significant at the trochanter only. Men categorized in the highest tertiles of alcohol intake (> 11 units/week) were younger (p = 0.3), had lower caffeine intake (p = 0.008), and had significantly higher gamma-glutamyltransferase levels (p = 0.002) than the other categories. The crude mean BMD at femoral neck, trochanter, and Ward's triangle was significantly higher in men who drank 1-4 units of alcohol per week. However, most of this association disappeared when BMD was adjusted for age and weight except at the trochanter.(ABSTRACT TRUNCATED AT 250 WORDS)