Oral Opioids for Chronic Non-cancer Pain: Higher Prevalence of Hypogonadism in Men than in Women

Abstract

The effect of chronic oral opioids on hypothalamus-pituitary-gonadal axis in women, and on bone mineral density (BMD) in men and women is not known. The objective of this cross-sectional study was to determine the effect of long-term oral opioids on gonadal status and BMD in male and female patients with chronic non-cancer pain (CNCP). We included 26 community-dwelling CNCP patients, 12 men and 14 premenopausal women, treated with oral opioids for at least one year. We obtained Visual Analogue Scale for pain score, BMD and plasma LH and FSH in all patients; menstrual history and estradiol in women; free androgen index and total and free testosterone in men. Men were older then women (p < 0.05) and had used opioids for a longer period (7.2 ± 3.8 and 4.1 ± 1.8 years, respectively; p < 0.05), but there was no difference in opioid dose or pain score between sexes. The prevalence of hypogonadism was high in men (75 %), while only 21 % of the women reported oligoor amenorrhea indicating hypogonadism (P < 0.01, between sexes). Osteopenia was found in 50 % of men and 21 % of women (p = NS). We conclude that in CNCP patients receiving chronic opioid therapy there is a much higher prevalence of hypogonadism in men then in women. This needs to be considered clinical practice.

Opium and Heroin Alter Biochemical Parameters of Human's Serum

“…Moreover, long-term consumption of opioids increases the prevalence rate of hypogonadism in males more than that in females (38). In another study, heroin consumption has caused hyperprolactinemia and low bone density (34).…”

Opioid-Induced Endocrinopathy: Diagnosis and Screening

“…Because many subjects with osteopenia bad testosterone in the normal range, the authors concluded that monitoring the total testosterone alone is not a reliable method to determine the risk for developing opioid-associated osteoporosis (14). Fraser et al (2009) reported similar findings (15). The authors reviewed the charts of 83 consecutive pain clinic patients.…”

Male hypogonadism: More than just a low testosterone

“…Long-term therapy with common medications such as opioids or corticosteroids can result in secondary hypogonadism. [18][19][20] Others are GnRH analogues such as leuprolide (Lupron), which are used in treating advanced prostate cancer. The hypogonadism is usually transient and resolves after stopping the offending agent.…”