Calcitonin and prolactin serum levels in heroin addicts: study on a methadone treated group

Prospective study of bone mineral density changes in aging men with or at risk for HIV infection

OBJECTIVE

To investigate rates and predictors of change in bone mineral density (BMD) in a cohort of aging men with or at risk for HIV infection.

DESIGN

A prospective cohort study among 230 HIV-infected and 159 HIV-uninfected men aged at least 49 years.

METHODS

Longitudinal analyses of annual change in BMD at the femoral neck, total hip, and lumbar spine.

RESULTS

At baseline, 46% of men had normal BMD, 42% had osteopenia, and 12% had osteoporosis. Of those men with normal BMD, 14% progressed to osteopenia and 86% continued to have normal BMD. Of the men initially with osteopenia, 12% progressed to osteoporosis and 83% continued to have osteopenia. Osteopenia incidence per 100 person-years at risk was 2.6 for HIV-uninfected men and 7.2 for HIV-infected men; osteoporosis incidence was 2.2 per 100 person-years at risk among men with osteopenia, regardless of HIV status. In multivariable analysis of annual change in BMD at the femoral neck, we found a significant interaction between heroin use and AIDS diagnosis, such that the greatest bone loss occurred with both AIDS and heroin use (adjusted predicted mean annual bone loss 0.0196 g/cm). Hepatitis C virus seropositivity was also associated with femoral neck bone loss (P = 0.04). The interaction between AIDS and heroin use also was associated with bone loss at the total hip, as was current methadone use (P < 0.01).

CONCLUSION

We found an association of heroin use and AIDS with BMD change, suggesting that heroin users with AIDS may be at particular risk for bone loss.

Altered sexual function and decreased testosterone in patients receiving intraspinal opioids

Altered sexual function has been reported in individuals addicted to opioids or on methadone maintenance, yet little literature is available regarding the effect of intraspinal opioids on libido or sex hormone levels. We evaluated sexual function and plasma sex hormone levels in six men treated with chronic intraspinal opioids. All patients had some reduction in libido and four patients had difficulty obtaining or maintaining an erection. These changes were noted within 1 month of beginning intraspinal opioid therapy. Serum testosterone levels ranged from 26 to 367 ng/dL (normal, 350-1500 ng/dL); the mean serum level was 197.7 ng/dL (SD = 119.8). Serum testosterone levels and other sex hormones, including follicle-stimulating hormone, luteinizing hormone, sex-hormone-binding globulin, and prolactin, should be measured prior to and at various points during intraspinal opioid therapy. Patients should be queried regarding sexual function and should be cautioned regarding the possibility of these adverse effects prior to initiating spinal opioids. Supplemental testosterone should be considered to treat this dysfunction.

Immunoreactive "calcitonin-like" material in heroin addicts: varying reactivity with different antibodies

High levels of immunoreactive calcitonin (iCT) in the blood of heroin addicts were previously reported. As it is well known that multiple forms of calcitonin exist in the blood and in tissues, the purpose of the present study was to investigate the immunological nature of the CT-like immunoreactive material found in the blood of these subjects. We investigated 25 addicts, who had been using heroin for more than one year and were hospitalized for a 2 week detoxication program. Blood samples were drawn at the start of the program (when the subjects were still on heroin) and after 5 and 12 days of abstinence from heroin. Twenty-five healthy subjects served as controls. We used 2 commercial RIA kits, calibrated against the same reference material (WHO 70-234), but employing different antisera. One antiserum substantially confirmed the previous findings of increased levels of calcitonin during heroin use, but the other seemed to exclude any change in the hormone concentrations. This suggests that the "calcitonin like" material found in heroin addicts contains some epitopes similar to those found in the calcitonin standard which are detected by the first antiserum. However it lacks other epitopes which are also present in calcitonin standard and which are recognized by the second antiserum. Therefore, this substance seems to be different from the standard human calcitonin 1-32. A possible involvement of a calcitonin analogue (precursor or metabolite) in the biochemical changes occurring during chronic opiate use is suggested.

Immunoheterogeneity of serum calcitonin in heroin addicts

Serum calcitonin (CT) concentrations were determined in 96 heroin addicts. CT levels were assayed by radioimmunological method employing two antisera, one vs. the 17-32 fraction (IMN) of the human CT, the other vs. the 11-32 fraction (B7). In heroin addicts the CT mean values were significantly higher (P less than 0.001) than in normal subjects (141 +/- 16.0 and 292 +/- 21.7 pg/ml with IMN-antiserum and with B7-antiserum, respectively, in heroin addicts; 64 +/- 7.8 and 189 +/- 21.7 pg/ml in controls). Serum CT levels assayed with B7-antiserum were notably higher (P less than 0.001) both in controls and in heroin addicts. Our results draw attention to the heterogeneity of high ICT values found in heroin addicts.