Patients on injectable diacetylmorphine maintenance have low bone mass

Abstract

Prolonged heroin dependence appears to be associated with lower-than-normal bone mass already at early age and these individuals might be at greater risk for fracture with advancing age. The negative correlation of age-adjusted Z-scores with increasing age suggests factors other than age for low BMD in this population (e.g. smoking, heroin use). Prospective studies are warranted to determine the necessity for diagnostic and preventive measures.

Angiotensin-(1-7)/Mas receptor as an antinociceptive agent in cancer-induced bone pain

“…35 The World Health Organization recommends mild-to-strong opioids for cancer pain 76 ; yet, opioid therapy is associated with several side effects contributing to their failure, 48 while diversion of prescribed opioids has led to an addiction epidemic. 4 Recently, reports in humans 10,14,60 and animals 21,72 suggest that opioids may exacerbate bone loss, which is counterproductive to antiosteolytic cotherapies and CIBP management. 16,47,66,75 Disturbingly, recent studies demonstrate an increase in the proliferation/migration of cancers with sustained opioids, 15,26,38,80 which is the exact condition patients with CIBP experience.…”

Opioid receptor agonists may favorably affect bone mechanical properties in rats with estrogen deficiency-induced osteoporosis

“…The population-based and clinical studies indicate rather damaging effects of opioids on bone leading to a reduction in bone mineral density (BMD) (Pedrazzoni et al 1993; Kim et al 2006; Fortin et al 2008; Dürsteler-MacFarland et al 2011; Grey et al 2011; Duarte et al 2013) and increased risk of fracture (Guo et al 1998; Ensrud et al 2003; Vestergaard et al 2006; Saunders et al 2010; Solomon et al 2010; Miller et al 2011; Carbone et al 2013; Li et al 2013), although recently two reports indicating possible favorable opioid effects on the skeletal system in women have been published (Vestergaard et al 2012; Lee et al 2013). The unfavorable effects of opioids on the skeletal system are usually attributed to inhibitory effects on the endocrine system (hypogonadism), as well as increased tendency to falls (Vestergaard et al 2006; Daniell 2008; Saunders et al 2010; Brennan 2013; Duarte et al 2013); however, results of a small number of in vitro and in vivo experimental studies suggest that opioids may also act directly on bone tissue and exert differential effects (Hall et al 1996; Pérez-Castrillón et al 2000; King et al 2007; Akhoundi et al 2010; Bastos et al 2011; Boshra 2011; Ezzatabadipour et al 2011; Chrastil et al 2013).…”

Bone mineral density and its determinants in men with opioid dependence

“…Men with long-term opioid dependency heroin-dependent patients on injectable heroin maintenance observed reduced bone mass with osteopenic values in 58 % and osteoporotic values in 16 % [6]. Our study comprised 144 men of comparable age but longer median duration of opioid consumption (21 vs. 14 years).…”

“…Low bone mass has been reported among illicit drug users and opioid users on long-term methadone maintenance treatment [4][5][6]. This might be due to life-style factors and comorbidities associated with long-term opioid consumption such as smoking [4,7], alcohol intake [8][9][10], advanced liver disease and cirrhosis [11][12][13][14], and low body-mass index or malnutrition [15,16].…”

“…Data on the effect of illicit drug use and substitution therapy on bone mass in men are limited due to the small number of men included in previous studies [4][5][6]. Within a large cohort of men on long-term opioid substitution, the aim of our study was (a) to evaluate the effect of opioid substitution on bone mineral density (i.e.…”