Bone Metabolism in Heroin Addicts and after Methadone Maintenance Treatment

Overview

Background.
The aim of the work was to determine how the prolonged opioid addiction influence bone metabolism.In heroin addicts and after one year of methadone maintenance we investigated bone mineral density, biochemicalmarkers of bone metabolism and serum levels of testosterone.Methods and Results. The study involved 37 persons, 31 men and 6 women in average age of 26 years (variation18 to 39 years). Values of type I collagen cross-linked telopeptide, osteocalcin, propeptide of type I collagen andtestosterone in serum were measured by radioimmunoassy and immunoanalysis. Bone mineral density was measuredby dual energy absorptiometry. Body Mass Index was calculated. In heroin addicts at the femoral neck and in distalforearm osteopenia was found. After one year of methadone maintenance treatment the bone density remainedunchanged. Concentrations of osteoresorption marker (type I collagen cross-linked telopeptide) and osteoformationmarkers (osteocalcin and propeptide of type I collagen) were in heroin addicts in comparison with control groupsignificantly increased (averages 814 ng/l, 43,1 µ/l, 76,4 µ/l). Testosterone level in serum in addicted men wassignificantly decreased (3,3 nmol/l). After one year of methadone maintenance treatment biochemical markers ofbonemetabolismrestored when compared with the control group, testosterone levels remained unchanged. Statisticalmeasurements were performed by t-test and paired t-test.Conclusions. Prolonged heroin addiction is associated with accelerated bone turnover and osteopenia in corticalbone without evidence of metabolic bone disease. Methadone maintenance treatment restores altered bone turnoveronly. One possible explanation of high bone turnover in heroin addicts may be the influence of hypopituitary-hypothalamo-gonadal axis. However, it may not be the only mechanism involved.

Key words:
heroin addiction, osteoresorption, osteoformation, testosterone, methadone.