Influence of Smoking on Bone Mineral Density in Elderly Men

The association of opioid consumption and osteoporosis in old men: Bushehr Elderly Health (BEH) program

In a population of 1156 men aged ≥ 60 years, opioid drug use was reported by 4.1% (n = 47) of participants. Among opioids, opium was the most prevalent consuming drug (83%). Adjusting for potential confounders, opioid consumption showed a positive association with osteoporosis.

PURPOSE

Limited evidence suggest a relationship between opioid consumption and osteoporosis. This study aims to investigate the possible association of osteoporosis and drug use among older adult men of Bushehr, Iran.

METHODS

In this study, 1156 men aged ≥ 60 years of Bushehr Elderly Health (BEH) were included. Bone density and trabecular bone score (TBS) were measured using dual-energy X-ray absorptiometry. Total osteoporosis was noted based on osteoporosis at either site of the lumbar spine, femoral neck, and total hip densitometry. Drug use was defined as a self-reported current use of opioid drugs, either regular (daily) use or irregular consumption. Multivariable modified Poisson regression analysis was used for investigating the association of opioids and osteoporosis, reporting the adjusted prevalence ratio (APR) with 95% confidence interval (CI). The association between drug use and TBS was evaluated using a linear regression model.

RESULTS

Opioid drug use was reported by 4.1% (n = 47) of participants. Among drug users, opium was the most prevalent consuming drug (83%). In all, 38.3% of drug users and 22.4% of non-users had osteoporosis (p-value = 0.011). Multivariable analysis showed that adjusting by age, education, smoking, alcohol consumption, body mass index, diabetes, and physical activity, a positive and significant association was detected between opioid drug use and the likelihood of osteoporosis (APR: 1.46, 95%CI: 1.02-2.10). Considering the potential confounders, the results also showed a negative association between drug consumption and TBS (β: - 0.027, 95%CI: - 0.053, - 0.001).

CONCLUSION

Opioid drug use has a positive association with osteoporosis in elderly men, independent of other conventional risk factors. Elderly drug users might be at a higher risk for osteoporotic fractures, given the effect of substance use on cognition. So, osteoporosis among drug users would be of importance, especially in countries where opium consumption is prevalent.

Effect of cigarette smoking on alveolar bone thickness and density in patients undergoing leveling and alignment of crowded lower anterior teeth: a controlled clinical trial

OBJECTIVE

To evaluate the effect of cigarette smoking on the alveolar bone thickness and density in patients undergoing leveling and alignment of crowded lower anterior teeth.

METHODS

This controlled clinical trial involved 17 smokers and 17 nonsmokers with mild to moderate crowding of the anterior mandibular teeth. Two cone-beam computed tomography images of the mandible were taken before and after treatment. The length of each tooth root was calculated in each T0 image, and the root was divided into three equal regions. Three lines were drawn parallel to the line of the cementoenamel junction at these three regions of the root, and the previously drawn lines were used to measure bone thickness and bone density.

RESULTS

The mean changes in cortical bone thickness and bone density were significantly smaller in smokers than nonsmokers. Cortical bone thickness and bone density were significantly lower after than before treatment in both smokers and nonsmokers.

CONCLUSION

In addition to all of its known dangers, cigarette smoking may also harm the alveolar bone by decreasing the bone thickness and density during orthodontic treatment in heavy smokers.

Correlation of serum cornitine levels with bone mineral density among Indian male tobacco users

It is of interest to assess levels of serum cornitine in male tobacco users and also find its correlation with bone mineral density. Assessment for serum cotinine levels was done using commercially available Enzyme Linked Immunosorbent Assay (ELISA Kit). While bone mineral density was measured using bone densitometry through ultrasound in the wrist region. Karl Pearson's coefficient was used to assess correlation between BMD values and serum cotinine (ng/ml) levels. Inter group BMD association was measured using Chi square test. The present study showed that the first 3 groups had a low BMD level compared to control group, indicative of osteopenia. BMD values were lesser for chewers from group II as compared to smokers from group I and individuals using both smoked and smokeless form of tobacco from Group III. In group III (both forms of tobacco), osteopenic individuals were more. Thus, data shows effect of tobacco usage on bone mineral density. Smokeless form of tobacco has relatively serious effects on bone density.

Association between maternal smoking and child bone mineral density: a systematic review and meta-analysis

Maternal smoking during pregnancy has detrimental effects on fetal development. The current review examined the differences in offspring's bone mineral density (BMD) between mothers smoked during pregnancy and those who did not. A systematic review and meta-analysis on the studies investigating the influence of maternal smoking during pregnancy on children or neonates' bone measures published up to October 30, 2018, was performed. BMD results measured at different body sites were pooled and then fixed or random effect models were used based on the presence of heterogeneity. The desired pooled effect size was the offspring's BMD mean difference with 95% confidence interval between smoker and non-smoker mothers. Sensitivity analysis was performed for birth weight and current weight, two important mediator/confounders causing heterogeneity. Overall, eight studies consisting of 17,931 participants aged from infancy to 18 years were included. According to the fixed effect model, the mean of BMD in offspring whose mothers smoked during pregnancy was 0.01 g/cm² lower than those with non-smoker mothers (95% CI = - 0.02 to - 0.002). However, subgroup meta-analysis adjusted for birth weight and current weight demonstrated no significant mean difference between BMD of children with smoker and non-smoker mothers (d = 0.06, 95% CI = -0.04 to 0.16, p value = 0.25 and d = - 0.005, 95% CI = - 0.01 to 0.004, p value = 0.28, respectively). According to available studies, it is suggested that maternal smoking during pregnancy does not have direct effect on the offspring's BMD. Instead, this association might be confounded by other factors such as placental weight, birth weight, and current body size of children.

Differential Effect of Long-Term Systemic Exposure of TNFα on Health of the Annulus Fibrosus and Nucleus Pulposus of the Intervertebral Disc

The inflammatory cytokine tumor necrosis factor alpha (TNFα) is considered to play a key role in the pathogenesis of intervertebral disc disease. To evaluate the importance of this cytokine we examined the inflammatory environment and spinal phenotype of 9-month-old human TNFα overexpressing transgenic (hTNFα-TG) mice. The mice evidenced increased circulating levels of interleukin-1β (IL-1β), IL-2, keratinocyte chemoattractant/human growth-regulated oncogene (KC/GRO), and monocyte chemoattractant protein-1 (MCP-1) along with thinning of the cortical and trabecular vertebral bone. Surprisingly, although the nucleus pulposus (NP) of these mice was intact and healthy, the caudal annulus fibrosus (AF) evidenced robust cell death and immune cell infiltration. Despite these differences, there were no obvious alterations in the collagen or aggrecan content in the NP and AF. However, there was a reduction in cartilage oligomeric matrix protein (COMP), suggesting destabilization of the AF matrix. Microarray analysis of the NP from hTNFα-TG mice cells revealed minimal changes in global gene expression. These findings lend support to the notion that NP tissue is isolated from systemic inflammation. In contrast, the severe AF phenotype suggests that systemic inflammation interferes with AF health, predisposing discs to herniation as opposed to directly causing NP degeneration. © 2020 American Society for Bone and Mineral Research.

Bone Mineral Density as a Predictor of Atherogenic Indexes of Cardiovascular Disease, Especially in Nonobese Adults

Purpose

This study is aimed at determining whether bone mineral density (BMD) values are related to atherogenic indexes (AIs) and could predict the risk of cardiovascular disease (CVD) in southern Taiwanese adults.

Methods

Medical records of 3249 adults who underwent health examinations between June 2014 and February 2018 at a regional hospital in southern Taiwan were reviewed. Data collected included health history, anthropomorphic characteristics, exercise habits, diets (vegetarian or nonvegetarian), clinical laboratory results (lipid profile, systemic blood pressure (SBP), glucose level, creatinine (Cre) level, and hemoglobin (Hb) level), and bone mineral density (BMD), which were used to identify the associations of these parameters, especially BMD, with lipid profile and calculated AIs through simple and multiple linear regressions.

Results

The mean age of the patients was 58.0 years, and 71.4% were male. Body mass index (BMI), SBP, glucose level, Cre level, Hb level, and all BMD values were positively correlated with triglyceride (TG) level and AIs and were negatively correlated with high-density lipoprotein cholesterol (HDL-C) level. The significant positive correlations of BMD at all the measured sites with AIs remained after adjusting for age, sex, SBP, glucose level, Cre level, Hb level, smoking, exercise habits, and vegetarian state. The expanded adjusting model for TG/HDL-C remained significant at all the BMD measured sites in nonobese men, at bilateral femoral neck and total hips in nonobese women, and at the bilateral total hips in obese women.

Conclusions

AIs are predictive markers for CVD, and BMD values are predictors of AIs, especially the novel AI, i.e., TG/HDL-C ratio, in nonobese adult men and women after dividing the patients into subgroups to eliminate the effect of BMI as a confounding factor. Thus, BMD values could predict AIs of CVD, especially in nonobese adults.

An update on the problem of osteoporosis in people with epilepsy taking antiepileptic drugs

INTRODUCTION

Antiepileptic drugs (AEDs) have been associated with a negative impact on bone health. Comorbid disorders in patients with epilepsy may require drugs exerting a pro-osteoporotic effect, so a possibility of untoward interactions with AEDs is probable.

AREAS COVERED

This review discusses evidence related to the deteriorating influence of AEDs on bone, demonstrating generally stronger negative effects of conventional AEDs. Lamotrigine seems to be a safer AED in this regard. Further, literature data indicate that generally AEDs can lower the serum concentration of vitamin D. Importantly, pediatric patients are of greater risk of bone problems during therapy with AEDs, which is probably due to their effects on bone-forming processes.

EXPERT OPINION

Supplementation with vitamin D and calcium is frequently recommended in patients taking AEDs chronically. Whether to add a bisphosphonate remains an open question due to the limited data on this issue. A possibility of negative interactions exists between AEDs and other pro-osteoporotic drugs: glucocorticoids, proton pump inhibitors and aromatase inhibitors. Depression is a frequent comorbidity in patients with epilepsy. Clinical data indicate that antidepressant drugs may also increase the risk of fractures. Again, patients with epilepsy and depression may be exposed to a greater risk of osteoporosis.