Alcohol and Bone Turnover Markers among People Living with HIV and Substance Use Disorder
Low bone density is common among people living with HIV, even those who have successfully suppressed their viral loads with antiretroviral therapy.
Now, a new Boston University School of Public Health study finds that alcohol further decreases bone formation in people living with HIV.
Published in the journal Alcoholism: Clinical and Experimental Research, the study found that each additional alcoholic drink per month was associated with lower the levels of a protein involved in bone formation.
Our finding highlights an under-recognized circumstance in which people with HIV infection often find themselves: Their viral load can be well controlled by efficacious, now easier-to-take medications, while other health conditions and risks that commonly co-occur – like substance use and other medical conditions – are less well-addressed,” says Richard Saitz, professor of community health sciences and the study’s senior author, as per BU School of Public Health.
For the current study, the researchers analyzed participants’ blood samples, looking at biomarkers associated with bone metabolism (a life-long process of absorbing old bone tissue and creating new bone tissue) and a biomarker associated with recent alcohol consumption. They found a significant association between a participant’s alcohol use and their levels of serum procollagen type 1 N-terminal propeptide (P1NP), a marker of bone formation. For every additional alcoholic drink per day on average, a participant’s P1NP levels dropped by 1.09ng/mL (the range for healthy P1NP levels is 13.7 to 42.4 ng/mL).
If I were counseling a patient who was concerned about their bone health, besides checking vitamin D and recommending exercise, I would caution them about alcohol use, given that alcohol intake is a modifiable risk factor and osteoporosis can lead to fracture and functional decline,” says study lead author Theresa W. Kim, an assistant professor at the School of Medicine and a faculty member of the Clinical Addiction Research Education (CARE) program at Boston Medical Center, who is also a primary care physician at the Boston Health Care for the Homeless Program.
— Dr. Richard Saitz (@UnhealthyAlcDrg) March 9, 2020
Although problem alcohol use and low bone density are prevalent among people living with HIV (PLWH), it is not clear whether alcohol use is associated with bone turnover markers (BTMs), and if so, at what quantity and frequency.
The study objective was to examine the association between alcohol and BTMs in PLWH with substance use disorder.
The researchers studied a prospective cohort recruited from 2 HIV clinics who met criteria for DSM‐IV substance dependence or reported ever injection drug use.
Outcomes were BTM of
- bone formation (serum procollagen type 1 N‐terminal propeptide [P1NP]) and
- bone resorption (serum C‐telopeptide type 1 collagen [CTx]).
Alcohol consumption measures included
- mean number of alcoholic drinks/d (Timeline Follow‐Back [TLFB]) (primary predictor),
- any alcohol use on ≥20 of the past 30 days, and phosphatidylethanol (PEth), a biomarker of recent alcohol consumption.
Linear regression analysis examined associations between
- each alcohol measure and each BTM and
- change in alcohol and change in BTM over 12 months.
Among 198 participants, baseline characteristics were as follows:
- The median age was 50 years; 38% were female; 93% were prescribed antiretroviral medications;
- 13% had ≥20 alcohol consumption days/month; mean alcoholic drinks/day was 1.93 (SD 3.89);
- change in mean alcoholic drinks/day was −0.42 (SD 4.18); mean P1NP was 73.1 ng/ml (SD 34.5); and mean CTx was 0.36 ng/ml (SD 0.34).
- Higher alcoholic drinks/day was significantly associated with lower P1NP (slope −1.09 ng/ml; 95% confidence interval [CI] −1.94, −0.23, per each additional alcoholic drink).
- On average, those who consumed alcohol on ≥ 20 days/month had lower P1NP (−15.45 ng/ml; 95% CI: −26.23, −4.67) than those who did not.
- Similarly, PEth level ≥ 8ng/ml was associated with lower P1NP. An increase in alcoholic drinks/d was associated with a decrease in P1NP non-significantly (−1.14; 95% CI: −2.40, +0.12; p = 0.08, per each additional drink).
- No significant associations were detected between either alcohol measure and CTx.
In this sample of PLWH with substance use disorder, greater alcohol consumption was associated with lower serum levels of bone formation markers.