Since ABO blood group differences are associated with varying responses to many diseases, ABO blood type and bone density were studied in 39 recovering male alcoholics, comparing those with blood type O and non-O. The type O subjects had significantly higher bone densities as measured by quantitative computed tomography of the vertebrae than the non-O subjects (175.4 +/- 8.5 and 140.7 +/- 7.6, respectively, p = 0.004). There were no differences in age and indices of their alcoholism. Using multiple stepwise regression analysis, neither race nor maximal amount of alcohol consumed appeared to contribute to the differences in bone density. Only age, number of years of regular alcohol use and ABO blood type were determinants of the bone density differences. The ABO blood type contributed 20.3% to the differences in bone density (p = 0.001). The patients with non-O blood type lost a significant amount of bone with advancing age (r = -0.76, p = 0.0001) while those with blood type O did not (r = -0.37, p = 0.11). We conclude that, although alcoholism is a factor in the development of osteopenia, in males the ABO blood group status plays a significant role in the maximal mineralization of the skeleton and the amount of bone resorption during ageing, independent of alcohol abuse.