Interactions among Substance use disorders, Inflammation, and Bone Health: a Crucial Role of the Brain-Bone Axis

Abstract Purpose of Review Substance use disorders (SUDs) or dependence on psychoactive drugs such as alcohol, tobacco, cannabis, cocaine, amphetamines, and opioids are widespread and contribute to and exacerbate the consequences of many diseases, including nervous and skeletal system disorders. The objective of this review was to provide a detailed overview of the interactions among SUDs, inflammation, and bone health, focusing on the brain-bone axis, as it is crucial in drug-induced damage to the central nervous system (CNS) and skeleton. Recent Findings SUDs are associated with elevated levels of reactive oxygen species, pro-inflammatory mediators in the systemic circulation and CNS, leading to neurodegeneration and disturbed bone metabolism. Systemic inflammation and immune system dysfunction contribute significantly to these symptoms. In addition to changes in neural circuitry and plasticity, SUDs can also result in decreased bone mass, reduced bone strength, and increased susceptibility to osteoporosis and fractures. Prolonged abstinence and/or significantly reduced intake of addictive substances have been shown to lower systemic inflammation and cause partial recovery from brain and bone damage in drug dependence. Summary Demonstrating that longer durations of sustained abstinence can be beneficial for both brain and bone health in SUDs is one of the best ways to encourage both individuals with SUDs and treatment providers to remain abstinent and participate in treatment. To raise awareness of harmful effects of psychoactive drugs also on the skeletal system, via the brain-bone axis, these findings should be disseminated.