Low bone density in patients receiving methadone maintenance treatment

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.