Drinking Weakens Bones of People Living with HIV.
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 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 drink per month was associated with lower the levels of a protein involved in bone formation.
“We did not find an amount of alcohol consumption that appeared ‘safe’ for bone metabolism,” 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.
“As you get older, your ability to maintain adequate bone formation declines,” Kim says. “These findings suggest that for people with HIV, alcohol may make this more difficult.”
“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.
The researchers used data from 198 participants in the Boston ARCH cohort, a long-running study led by Saitz and funded by the National Institute on Alcohol Abuse and Alcoholism that includes people living with HIV and current or past alcohol or drug use disorder.
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 also used data from interviews in their analyses, and controlled for other factors such as age, sex, race/ethnicity, other substance use, medications, vitamin D levels, and HIV viral suppression.
They found a significant association between a participant’s drinking and their levels of serum procollagen type 1 N-terminal propeptide (P1NP), a marker of bone formation. For every additional 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). Participants who drank more than 20 days out of each month also had lower P1NP levels than those who drank fewer than 20 days per month, and participants with high levels of the alcohol-associated biomarker also had lower P1NP levels.
“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 Kim, who is also a primary care physician at the Boston Health Care for the Homeless Program.
The study was co-authored by: Michael Winter, associate director of statistical programming at the Biostatistics & Epidemiology Data Analytics Center; Timothy C. Heeren, professor of biostatistics; Alicia Ventura and Alexander Walley (SPH’07) of the CARE program at Boston Medical Center; Michael F. Holick of Boston Medical Center and the School of Medicine; and Kendall J. Bryant of the National Institute on Alcohol Abuse and Alcoholism.