Hypogonadism and low bone mineral density in patients on long-term intrathecal opioid delivery therapy

Duarte, Rui; Raphael, Jacob; Southall, Jane L.; Labib, M; Whallett, Andrew; Ashford, Robert

doi:10.1136/bmjopen-2013-002856

Cited by 42 publications

(31 citation statements)

References 51 publications

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“…These findings replicate our earlier pilot study and a recent study by Duarte et al. of 20 patients receiving intrathecal opioids for chronic benign pain . We have extended this finding to study the effects of supplementary testosterone treatment on BMD.…”

Section: Discussionsupporting

confidence: 90%

Effects of Testosterone Treatment on Bone Mineral Density in Hypogonadal Men Receiving Intrathecal Opioids

Finch

Price²,

Pullan

et al. 2014

Pain Practice

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Reprints will not be available from the authors. AKNOWLEDGEMENTSThe authors of this paper wish to acknowledge and thank Dr Roger Goucke, DrJohn Salmon and Dr Thomas Berrigan for assistance in recruiting patients for this study and Dr Andrew Patrikeos for advice on bone mineral density estimation. ABSTRACTOpioid induced depression of sex hormones is a common finding in chronic pain patients receiving long-term opioids by oral, parenteral and even intrathecal routes of administration. The hypothalamic suppression by opioids leads to a hypogonadal state with low testosterone levels in males and subsequent low bone mineral density (BMD). We have studied the effects of intrathecallyadministered opioids on BMD in a group of male chronic pain patients. In addition, we have studied the effects of supplementary testosterone on bone metabolism to see if the adverse effects of intrathecal opioids can be reversed.Eleven of the 27 patients were on supplementary testosterone having previously been diagnosed as hypogonadal with low serum testosterone. Duration of testosterone supplementation was greater than 2 years in all 11 patients. Both serum total and free testosterone levels were higher in patients on supplementary testosterone than in patients who did not receive this treatment.Of the 16 patients not on testosterone supplement, 14 (87%) had low serum testosterone levels (<10 nmol/L) and 11 (69%) had low or osteoporotic T scores. Within this group, low free testosterone was associated with low BMD scores, and this persisted after correcting for age. Eight of the patients on testosterone supplement had normal BMDT scores and three (27%) had low or osteoporotic T scores. T and age-corrected BMDZ-scores were significantly greater in the 11 patients on testosterone supplements than BMD scores in the other 16 patients. Testosterone supplementation was found to largely correct the effects of intrathecal opioids on testosterone levels and BMD.

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Section: Discussionsupporting

confidence: 90%

Effects of Testosterone Treatment on Bone Mineral Density in Hypogonadal Men Receiving Intrathecal Opioids

Finch

Price²,

Pullan

et al. 2014

Pain Practice

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“…Two studies have shown a very high prevalence of hypogonadism in men receiving intrathecal opioids [9,10]. Nonetheless, the BMD data in this population show inconsistent findings.…”

Section: Opioids Hypogonadism and Bonementioning

confidence: 88%

“…Nonetheless, the BMD data in this population show inconsistent findings. One study looked at BMD in 20 men aged 47-69 years with chronic noncancer pain who were all receiving intrathecal morphine for a median duration of 100 months [9]. In this study, 75% of patients had biochemical hypogonadism with a calculated free testosterone less than 52 pg/ml (<180 pmol/l).…”

Section: Opioids Hypogonadism and Bonementioning

confidence: 99%

Bone health in hypogonadal men

Irwig

2014

Current Opinion in Urology

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“…Untreated, low sex hormones can lead to osteopenia and osteoporosis in both men and women 43 44. In men, the aim of treatment is to restore normal testosterone levels in order to improve quality of life, sense of well-being, sexual function, muscle strength and bone mineral density.…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

The effects of opioids on the endocrine system: an overview

Ali

Raphael

Khan

et al. 2016

Postgraduate Medical Journal

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Opioids commonly used for pain relief may lead to hypogonadism, which is characterised by suppression of production of the gonadotropin-releasing hormone (GnRH) resulting in inadequate production of sex hormones. The aim of this narrative review was to highlight the effects of opioids on the endocrine system and the development of hypogonadism. MEDLINE, EMBASE and Cochrane Library were searched for relevant articles investigating hypogonadism in patients undertaking opioid therapy by using a combination of both indexing and free-text terms. The suppression of GnRH leading to a decrease in sex hormones has been described as the principal mechanism of opioid-induced hypogonadism. However, there is no consensus on the threshold for the clinical diagnosis of hypogonadism. Evidence indicates that chronic opioid use can lead to hypogonadism. Clinicians should be aware of symptomatology associated with hypogonadism and should regularly monitor patients with appropriate laboratory investigations.

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Hypogonadism and low bone mineral density in patients on long-term intrathecal opioid delivery therapy

Cited by 42 publications

References 51 publications

Effects of Testosterone Treatment on Bone Mineral Density in Hypogonadal Men Receiving Intrathecal Opioids

Effects of Testosterone Treatment on Bone Mineral Density in Hypogonadal Men Receiving Intrathecal Opioids

Bone health in hypogonadal men

The effects of opioids on the endocrine system: an overview

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