Illicit drug use linked to bone loss in middle-aged women
MedWire News: Illicit drug use is associated with reduced bone density in middle-aged women, research suggests.
The study, published in the journal Maturitas, assessed the bone mineral density (BMD) of a New York cohort of HIV-infected women and women at risk for HIV infection, including illicit drug users. It showed a modest HIV-associated bone loss and identified illicit drug use as an osteoporotic risk factor.
"Multiple endocrine and metabolic abnormalities, including central hypogonadism have been described in HIV-infected patients, and opiate use may contribute to these problems," explain the researchers.
"Although opioid users, particularly those infected with HIV, appear to be at increased risk for reduced BMD, the epidemiology and pathogenesis of bone loss in this population is virtually unexplored."
The BMD of 245 HIV-infected women (mean age 45.0 years) and 219 uninfected women (mean age 46.1 years), was compared at baseline and after 18 months. Half the women were HIV-positive, 50% of infected and uninfected women reported illicit drug use in the past 5 years, and 50% reported other high-risk behaviors.
At the start of the study, 19% of the participants were postmenopausal and a further 8% became so over the study period.
The research team, led by Anjali Sharma (SUNY Downstate Medical Center, New York, USA), found that the HIV-infected women had lower femoral neck and total hip BMD than the uninfected women at baseline. However, the rates of BMD change over the course of the study did not differ significantly according to HIV status, after adjusting for baseline BMD. In fact, other bone loss risk factors, such as age, menopausal status, low body mass index, and smoking had a greater impact on BMD than HIV.
Analysis suggests that HIV treatment might mitigate the negative effect of HIV infection on bone. HIV-infected women with no history of protease inhibitor use had significantly greater bone loss at the lumbar spine than women who had received protease inhibitors (-0.009g/cm3 vs no change). There was no association between BMD change and use of other classes of antiretrovirals.
The research also shows an independent significant positive association between history of methadone use and bone loss in the women in the cohort.
"As more women with HIV infection and opioid use survive to older ages, there is an increasing need to better identify those women at risk for fracture, and to examine whether current therapeutic interventions to prevent fractures will be helpful in these special sub-populations of women," Sharma et al conclude.
By Chloe McIvor