Bone mineral density and its determinants in men with opioid dependence
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Data on the influence of opioid substitution therapy (OST) on skeletal health in men is limited. This cross-sectional study aimed to determine the prevalence of low bone mass in male drug users and to evaluate the relationship between endogenous testosterone and bone mass. We recruited 144 men on long-term opioid maintenance therapy followed in the Center of Addiction Medicine in Basel, Switzerland. Data on medical and drug history, fracture risk and history of falls were collected. Bone mineral density (BMD) was evaluated by densitometry and serum was collected for measurements of gonadal hormones and bone markers. 35 healthy age- and BMI-matched men served as the control group. The study participants received OST with methadone (69 %), morphine (25 %) or buprenorphine (6 %). Overall, 74.3 % of men had low bone mass, with comparable bone mass irrespective of OST type. In older men (≥40 years, n = 106), 29.2 % of individuals were osteoporotic (mean T-score −3.0 ± 0.4 SD) and 48.1 % were diagnosed with osteopenia (mean T-score −1.7 ± 0.4 SD). In younger men (n = 38), 65.8 % of men had low bone mass. In all age groups, BMD was significantly lower than in age-and BMI-matched controls. In multivariate analyses, serum free testosterone (fT) was significantly associated with low BMD at the lumbar spine (p = 0.02), but not at the hip. When analysed by quartiles of fT, lumbar spine BMD decreased progressively with decreasing testosterone levels. We conclude that low bone mass is highly prevalent in middle-aged men on long-term opioid dependency, a finding which may partly be determined by partial androgen deficiency.
KeywordsOsteoporosis Opioid dependence Testosterone Bone mineral density
We would like to thank all patients for their willingness to participate in the study. We thank the staff involved in the Basel Center for Addiction Medicine and the Division of Endocrinology, University Hospital Basel for their patience in dealing with our study participants, with special thanks to Mrs. Kradolfer. The study was supported by unrestricted educational grants from “Freiwillige Akademische Gesellschaft Basel”, “Verein für Drogenarbeit Basel”, and Roche Pharma (Switzerland).
Compliance with ethical standards
Conflict of interest
Nothing to declare.
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