Cannabis is the most widely used illegal drug in the. USA. ⢠Prevalence of past-year use has more than doubled over the last decade (4.1% in 2002 to 9.5% in ...
Cannabis use and bone mineral density: NHANES 2007–2010 Donald S. Bourne, Wesley V. Plinke, Elizabeth R. Hooker, Carrie M. Nielson School of Public Health, Oregon Health & Science University; Portland, OR, USA
INTRODUCTION
RESULTS
RESULTS (continued)
Table 1 Selected characteristics of the study cohort by cannabis use (n= 4,743). Results are presented as mean ± SE or count (percentage) unless otherwise indicated.
• Cannabis is the most widely used illegal drug in the USA • Prevalence of past-year use has more than doubled over the last decade (4.1% in 2002 to 9.5% in 2013)1 • Cannabis use is associated with increased risk of adverse health outcomes such as periodontitis and higher blood pressure2,3 • In vitro and rodent models suggest endocannabinoid system plays a role in bone metabolism4 Objective • To determine association between cannabis use and BMD, of the femur and spine, in US population
Never Used Cannabis (n=2,162)
Former User of Cannabis (n=1,933)
Light User of Cannabis (n=263)
Heavy User of Cannabis (n=385)
39.9 ± 0.4
40.1 ± 0.5
34.7 ± 1.2
33.8 ± 0.7
1,222 (56.1)
922 (48.1)
118 (46.4)
119 (27.2)
Race/ethnicity Non-Hispanic White Mexican American Other Hispanic Non-Hispanic Black Other race or multi-racial BMI (kg/m2) Family income to poverty ratio Alcohol intake (drinks/day)
734 (57.1) 601 (14.1) 316 (7.4) 358 (11.1) 153 (10.3) 28.4 ± 0.2 3.0 ± 0.1 1.9 ±0.1
1,122 (78.3) 239 (5.5) 152 (3.5) 361 (9.5) 59 (3.2) 27.8 ± 0.1 3.4 ± 0.1 2.8 ± 0.1
127 (66.9) 26 (5.6) 24 (5.1) 78 (18.6) 8 (3.8) 26.9 ± 0.3 2.7 ± 0.1 3.8 ± 0.2
197 (67.6) 32 (5.0) 28 (4.6) 107 (18.2) 21 (4.7) 26.7 ± 0.3 2.5 ± 0.1 4.4 ± 0.3
Ever smoked tobacco
473 (19.2)
1,025 (51.18)
170 (64.1)
292 (75.3)
Tobacco smoking (pack-years) among ever-smokers, median (IQR)
6.0 (14.7)
9.0 (18.5)
6.5 (18.0)
9.0 (18.5)
62 (2.0)
558 (27.7)
95 (40.0)
187 (52.9)
30.0 (60)
30 (90)
30 (105)
45 (120)
Ever taken glucocorticoids daily
77 (4.0)
77 (4.1)
6 (2.3)
18 (3.2)
Parental history of osteoporosis
209 (11.4)
205 (13.2)
18 (8.6)
29 (9.1)
Total femur BMD (gm/cm2)
0.99 (0.01)
1.00 (0.003)
1.01 (0.01)
1.02 (0.01)
Total spine BMD (gm/cm2)
1.04 (0.004)
1.06 (0.002)
1.06 (0.01)
1.06 (0.01)
Age (years) Female
Ever used illegal drugse Physical activity (mins/day), median (IQR)
Never Users (45%) Former Users (41%) Light Users (6%) Heavy Users (8%)
• Unadjusted model: former and heavy cannabis use positively associated with femur BMD, heavy cannabis use positively associated with spine BMD • Fully adjusted model: no association between selfreported cannabis use and BMD was observed for any level of use (p≥0.28)
DISCUSSION • First study to examine the association between cannabis use and BMD at the population level in the USA • Findings are of public health significance due to growing legalization of cannabis in the US and the limited evidence of either advantageous or deleterious musculoskeletal associations with its use
METHODS • Utilized National Health and Nutrition Examination Survey, a complex, stratified, multistage probability cluster sampling design on nationally representative sample of non-institutionalized US population • NHANES 2007-2010 cycles, 4743 participants (20-59 years old) were categorized into never, former (previous use, but not in last month), light (1-4 days use in last month), and heavy (≥5 days use in last month) • Multivariable linear regression used to test association between cannabis use and DXA BMD (g/cm2) of the proximal femur and lumbar spine with adjustment for age, sex, BMI, and race/ethnicity among other BMD determinants.
Figure 1 Association between cannabis use and BMD in multivariate linear regressiona
Table 2 Associations between cannabis use and BMD in fully adjusted linear regression models (n = 4743) a a Total proximal femur BMD Total spine BMD b b Cannabis Use β (95% CI) p value β (95% CI) p value Never Reference Reference c Former 0.01 (−0.05, 0.06) 0.84 0.03 (−0.02, 0.07) 0.28 d Light 0.03 (−0.06, 0.12) 0.53 −0.01 (−0.10, 0.09) 0.89 e Heavy 0.01 (−0.10, 0.11) 0.91 0.03 (−0.05, 0.11) 0.47 a
Fully adjusted models were adjusted for age, sex, BMI, race/ethnicity, alcohol, illicit drug use (cocaine, heroin, methamphetamines), cigarette pack- years, physical activity, income, and glucocorticoid use b Coefficients were standardized based on the standard deviation of BMD: total femur BMD SD = 0.17 g/cm2 ; total spine BMD SD = 0.19 g/cm2 days c Used cannabis on ≥1 occasion in lifetime, but not in the previous 30 d Current user with 1–4 days of cannabis use in the previous 30 days e Current user with ≥5 days of cannabis use in the previous 30 days
Limitations • Cross-sectional design • Self-reported cannabis use is subject to misclassification, may bias results towards null due to misreporting occurring comparably across BMD distribution • Lacked data on history of lifetime cannabis use and quantity of use
REFERENCES 1 Grucza
RA et al. (2016) Recent trends in the prevalence of marijuana use and associated disorders in the United States. JAMA Psychiatry 73(3):300–301 2 Alshaarawy O, Elbaz HA (2016) Cannabis use and blood pressure levels: United States National Health and Nutrition Examination Survey, 2005-2012. J Hypertens 34(8):1507–1512 3 Shariff JA et al. (2017) Relationship between frequent recreational cannabis (marijuana and hashish) use and periodontitis in adults in the United States : National Health and Nutrition Examination Survey 2011 to 2012. JPeriodontol 88(3):273-80 4 Idris AI et al. (2005) Regulation of bone mass, bone loss and osteoclast activity by cannabinoid receptors.Nat Med 11(7):774–779
