Short communicationLow bone density in patients receiving methadone maintenance treatment
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
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