Sophocleous Antonia, Robertson Roy, Ferreira Nuno B, McKenzie James, Fraser William D, Ralston Stuart H
Rheumatology and Bone Diseases Unit, Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, UK.
Muirhouse Medical Group, Edinburgh, UK; Centre for Population Health Sciences, University of Edinburgh, UK.
Am J Med. 2017 Feb;130(2):214-221. doi: 10.1016/j.amjmed.2016.07.034. Epub 2016 Sep 2.
To investigate possible associations between recreational cannabis use and bone health in humans.
Cross-sectional study of individuals recruited from primary care in the UK between 2011 and 2013. Cases were regular smokers of cannabis divided into moderate (n = 56) and heavy user (n = 144) subgroups depending on whether they reported fewer or more than 5000 cannabis smoking episodes during their lifetime. Controls comprised 114 cigarette smokers.
Heavy cannabis users had lower total hip bone mineral density (mean ± SD Z-score: -0.20 ± 0.9 vs +0.2 ± 0.9, P < .0005), lower spine bone mineral density (-0.5 ± 1.2 vs 0.0 ± 1.2, P < .0005), and lower body mass index (BMI; 26.5 ± 6.0 vs 29.0 ± 7.0, P = .01) than controls. Fracture rate was also increased in heavy users (rate ratio = 2.17; 95% confidence interval, 1.59-2.95; P < .001). When compared with controls, serum cross-linked C-telopeptide of type 1 collagen (CTX) concentrations were raised in heavy cannabis users (0.3 ± 0.1 vs 0.2 ± 0.1 pg/mL, P = .045), as were serum N-terminal propeptide of type 1 procollagen (P1NP) concentrations (47.1 ± 19.2 vs 41.2 ± 17.8 pg/mL, P = .01). Serum total 25-hydroxyvitamin D concentrations were reduced in heavy users compared with controls (25.3 ± 16.8 vs 36.9 ± 26.7 nmol/L, P = .002). Multiple regression analysis revealed that heavy cannabis use was an independent predictor of spine bone mineral density, accounting for 5.4% of the variance (P = .035), and total hip bone mineral density, accounting for 5.8% of the variance (P = .001), but mediation analysis suggested that the effect on spine bone mineral density was indirect and mediated through low body mass index.
Heavy cannabis use is associated with low bone mineral density, low BMI, high bone turnover, and an increased risk of fracture. Heavy cannabis use negatively impacts on bone health both directly and indirectly through an effect on BMI.
研究人类使用消遣性大麻与骨骼健康之间可能存在的关联。
对2011年至2013年间从英国初级保健机构招募的个体进行横断面研究。病例为大麻经常使用者，根据其一生中报告的大麻吸食次数是否少于或多于5000次，分为中度使用者亚组（n = 56）和重度使用者亚组（n = 144）。对照组包括114名吸烟者。
重度大麻使用者的全髋骨矿物质密度较低（平均±标准差Z评分：-0.20±0.9 vs +0.2±0.9，P <.0005），脊柱骨矿物质密度较低（-0.5±1.2 vs 0.0±1.2，P <.0005），且体重指数（BMI）低于对照组（26.5±6.0 vs 29.0±7.0，P =.01）。重度使用者的骨折率也有所增加（率比 = 2.17；95%置信区间，1.59 - 2.95；P <.001）。与对照组相比，重度大麻使用者的血清1型胶原交联C末端肽（CTX）浓度升高（0.3±0.1 vs 0.2±0.1 pg/mL，P =.045），血清1型前胶原N末端前肽（P1NP）浓度也升高（47.1±19.2 vs 41.2±17.8 pg/mL，P =.01）。与对照组相比，重度使用者的血清总25-羟基维生素D浓度降低（25.3±16.8 vs 36.9±26.7 nmol/L，P =.002）。多元回归分析显示，重度大麻使用是脊柱骨矿物质密度的独立预测因素，占变异的5.4%（P =.035），也是全髋骨矿物质密度的独立预测因素，占变异的5.8%（P =.001），但中介分析表明，对脊柱骨矿物质密度的影响是间接的，通过低体重指数介导。
重度大麻使用与低骨矿物质密度、低BMI、高骨转换率以及骨折风险增加有关。重度大麻使用通过对BMI的影响直接和间接对骨骼健康产生负面影响。
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