Objectives To assess the association between alcohol consumption and healthy Korean young women bone by Alcohol Use Disorders Identification Test (AUDIT) scores and drinking consumption; frequency and amount.

Design Cross-sectional study composed of three parts: health interview, health examination, nutrition survey.

Setting 2008–2011 Korea National Health and Nutrition Examination Survey.

Participants Of the 21 303 participants whose bone mineral density (BMD) was assessed, 1176 healthy women aged 19–30 years were selected.

Primary and secondary outcome measures Mean BMD T-scores of the total femur (TF), femur neck (FN) and lumbar spine (LB) by drinking consumption and AUDIT scores, and the odds of having a low BMD (T-score <−1) at the sites by AUDIT scores.

Results After adjustment, lower BMD was found at three sites in those who drank more and had higher AUDIT scores. These associations were significant by AUDIT scores at TF (p=0.002) and FN (p=0.004) and by drinking frequency and amount at FN (p=0.029 and 0.039, respectively). The adjusted OR of having low BMD increased significantly, particularly at FN, in those who had higher AUDIT scores such as 16–17 harmful drinking (OR 4.31; 95% CI 1.16 to 16.06) and 20–40 alcohol dependence (OR 5.99; 95% CI 1.69 to 21.21), compared with young women who scored 0–7 low-risk drinking or abstinence. No beneficial effect of moderate drinking was observed at any of the sites and the association between alcohol consumption and bone health was most evident at FN.

Conclusions It is crucial to promote the awareness of alcohol harm on Korean young women's bone health. At the same time, since alcohol's effect on the bone is complex with cumulative effects of various factors over the years and there is an absence of studies with young women in their twenties, more studies, in particular for FN, are needed with more precise and appropriate design to confirm our findings.