Methadone Contributes to Bone and Dental Disease: Fact or Fiction?

Patients receiving or considering methadone maintenance treatment (MMT) for opioid dependence often express concern that methadone causes bone disease and dental decay. Although this has long been considered a misconception, low bone density has been noted in some MMT patients. This cross-sectional study sought to determine the prevalence and risk factors associated with vitamin-D deficiency in patients receiving MMT. Deficiency was defined as a 25-hydroxyvitamin D level less than 20 ng/mL, while insufficiency was defined as a level between 20–30 ng/mL.

• Of the 93 patients enrolled in the study, 36% had evidence of vitamin-D deficiency and an additional 16% had evidence of insufficiency.

• Vitamin-D deficiency was associated with age over 40 (odds ratio [OR], 3.47) and black or Hispanic race/ethnicity (OR, 3.34).

• Longer enrollment in MMT was not associated with vitamin-D deficiency.

Comments:

Although causation cannot be inferred and a model adjusting for all independent variables could not be constructed due to limited outcome cases, this small cross-sectional study did demonstrate a high prevalence of vitamin-D deficiency among patients receiving MMT. These findings are important since vitamin-D deficiency can lead to musculoskeletal pain, osteoporosis, and periodontal disease, all of which are common among MMT patients. Further investigation is needed to better understand the association between MMT, other risk factors (e.g., smoking), and vitamin-D deficiency.

Jeanette M. Tetrault, MD

Reference:

Kim TW, Alford DP, Holick MF, et al. Low vitamin D status of patients in methadone maintenance treatment. J Addiction Med. 2009;3(3):134–138.