Elsevier

Drug and Alcohol Dependence

Volume 85, Issue 3, 1 December 2006, Pages 258-262
Drug and Alcohol Dependence

Short communication
Low bone density in patients receiving methadone maintenance treatment

https://doi.org/10.1016/j.drugalcdep.2006.05.027Get rights and content

Abstract

Aim

To examine the frequency and severity of low bone mineral density (BMD) among patients enrolled in a methadone maintenance treatment (MMT) program and to ascertain risk factors for low BMD in this population.

Design

Cross-sectional.

Measurements

Data derived from standardized survey, medical record review, and dual energy X-ray densitometry (DXA).

Results

DXA results were below normal in 83% (76/92) of the study sample with T-scores <−2.5 (osteoporosis range) in 35% [32/92] and between −1.0 and −2.5 (osteopenia range) in 48% [44/92]. Risk factors for low BMD were common: tobacco use, 91%; heavy alcohol use, 52%; and HIV infection, 28%. Only 17% (16/92) were on medications that lower the risk of osteoporosis: estrogen (n = 5), testosterone (n = 4), calcium (n = 4), and Vitamin D (n = 2). None of the participants reported a known diagnosis of osteoporosis. In bivariate analyses, significant predictors of low BMD were: male gender (p < 0.001), lower weight (p = 0.009), and heavy alcohol use (p = 0.02).

Conclusion

More than three quarters of this sample of patients in a MMT program had low BMD. Treatable conditions associated with low BMD were commonplace. Efforts to increase awareness of low BMD in MMT patients should be considered so that effective treatment may be employed to lower future fracture risk.

Section snippets

Background

Osteoporosis is a systemic disease, characterized by low bone mineral density (BMD) and micro-architectural deterioration, predisposing to fracture after minimal trauma or fall. Osteoporosis-related fractures are associated with physical functioning decline (Fink et al., 2003), impaired ambulation, and premature mortality (Johnell et al., 2004). Although effective treatment exists to reduce the risk of future fracture (Wilson, 2004), osteoporosis is underecognized and undertreated (Neuner et

Study design and sampling

This was a cross-sectional study of participants recruited from the Boston Public Health Commission's Methadone Maintenance Treatment Program. Patients were excluded from the study if they were (1) pregnant due to radiation exposure during BMD measurement or (2) over 300 lb. due to mechanical limitations of the dual energy X-ray densitometry (DXA) table.

Data collection

Research associates administered standardized interviews assessing the following: demographics; Vitamin D and calcium supplementation; tobacco,

Sample characteristics

Characteristics of the study sample (n = 92) are listed in Table 1. No statistically significant differences were found between the study sample and the entire MMT clinic population (n = 350) in terms of age, gender, or race/ethnicity.

Median opioid use (i.e., heroin or prescription opioids) prior to enrollment in MMT was 14 years and duration of participation in MMT varied widely. One-third of women reported cessation of menses for more than one year; this subgroup had a median age of 42 years

Discussion

We found that more than three quarters of patients recruited from one MMT clinic had abnormally low BMD. These findings indicate that patients in MMT programs may be at higher risk for fracture than the general population. Increased fracture risk in this population has particular significance given the high rates of injuries (Rees et al., 2002) and worse physical functioning (De Alba et al., 2004, Friedmann et al., 2003) in individuals with addictions.

We also found that a high percentage had

Acknowledgements

The authors appreciate the invaluable contributions of Suzette Levenson, Ph.D. of the Boston University School of Public Health Data Coordinating Center for data management. Support for Theresa Kim came from the National Institute Drug Abuse (R25-DA13582). Support for this study came from the following grants: the Boston University Department of Medicine Pilot Project Grant and the Clinical Research Feasibility Fund. This research was conducted in part at the General Clinical Research Center at

References (32)

  • P.D. Friedmann et al.

    Predictors of follow-up health status in the Drug Abuse Treatment Outcome Study (DATOS)

    Drug Alcohol Depend.

    (2003)
  • C. Amiel et al.

    BMD is reduced in HIV-infected men irrespective of treatment

    J. Bone Miner. Res.

    (2004)
  • J.H. Arnsten et al.

    HIV infection and bone mineral density in middle-aged women

    Clin. Infect. Dis.

    (2006)
  • H.W. Daniell

    Opioid osteoporosis

    Arch. Intern. Med.

    (2004)
  • I. De Alba et al.

    Burden of medical illness in drug- and alcohol-dependent persons without primary care

    Am. J. Addict.

    (2004)
  • H.A. Fink et al.

    Disability after clinical fracture in postmenopausal women with low bone density: the fracture intervention trial (FIT)

    Osteoporos. Int.

    (2003)
  • L. Gennari et al.

    Longitudinal association between sex hormone levels, bone loss, and bone turnover in elderly men

    J. Clin. Endocrinol. Metab.

    (2003)
  • M. Hummer et al.

    Osteoporosis in patients with schizophrenia

    Am. J. Psychiatry

    (2005)
  • Institute of Medicine, 2006. Improving the Quality of Health Care for the Mental and Substance-Use Conditions, The...
  • K. Izumotani et al.

    Risk factors for osteoporosis in men

    J. Bone Miner. Metab.

    (2003)
  • O. Johnell et al.

    Mortality after osteoporotic fractures

    Osteoporos. Int.

    (2004)
  • A. Licata

    Osteoporosis in men: suspect secondary disease first

    Cleve. Clin. J. Med.

    (2003)
  • J.R. Mertens et al.

    Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO: comparison with matched controls

    Arch. Intern. Med.

    (2003)
  • N. Mikhail

    Hypogonadism and osteoporosis in men

    Arch. Intern. Med.

    (2003)
  • K. Mondy et al.

    Longitudinal evolution of bone mineral density and bone markers in human immunodeficiency virus-infected individuals

    Clin. Infect. Dis.

    (2003)
  • M.E. Mussolino et al.

    Depression and bone mineral density in young adults: results from NHANES III

    Psychosom. Med.

    (2004)
  • Cited by (112)

    • Opioid-induced endocrinopathies

      2020, The Lancet Diabetes and Endocrinology
    • State-of-the-art treatment of opioid use disorder

      2018, The Assessment and Treatment of Addiction: Best Practices and New Frontiers
    • Clinical trial of the effects of vitamin D supplementation on psychological symptoms and metabolic profiles in maintenance methadone treatment patients

      2017, Progress in Neuro-Psychopharmacology and Biological Psychiatry
      Citation Excerpt :

      In an animal study by Sadava et al. (1997) it was observed that MMT was associated with a metabolic state equal with insulin-resistant diabetes. Previous studies have documented that hypovitaminosis D and low bone mineral density (BMD) were present in a majority of subjects recruited from an MMT program (Kim et al., 2009; Kim et al., 2006). Hypovitaminosis D may associated with nonspecific musculoskeletal pain (Plotnikoff and Quigley, 2003), periodontal disease (Dietrich et al., 2004), and increased risk of fracture (Hannan et al., 2008).

    View all citing articles on Scopus
    View full text