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Opioid Osteoporosis
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Ensrud et al1 controlled for a large variety of factors in establishing the higher fracture frequency among their elderly opiate-consuming women. Their investigation confirms the results of several previous, less comprehensive studies, which they cite.2-3 Discussion by each of these groups of investigators, however, only addresses the potential contribution to this increased fracture risk by the cognitive effects of these analgesics. A variety of observations indicate that the influence of opiates on other organ systems may substantially contribute directly or indirectly to opioid-associated bone fractures.
Chronic hypogonadism is a prominent cause of osteoporosis in both sexes. We have easily identified several hundred men and women with opioid-induced hypogonadism in our community of 80 000 people including mostly men using opioids in sustained-action dosage forms. We have recently reviewed some of the large body of evidence documenting the frequency of and mechanism producing opioid-induced androgen deficiency (OPIAD).4-5 This complication of analgesic therapy . . . [Full Text of this Article]
Harry W. Daniell, MD
Redding, Calif
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Opioid Osteoporosis—Reply
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Central Nervous System Active Medications and Risk for Fractures in Older Women
Kristine E. Ensrud, Terri Blackwell, Carol M. Mangione, Paula J. Bowman, Douglas C. Bauer, Ann Schwartz, Joseph T. Hanlon, Michael C. Nevitt, and Mary A. Whooley
Arch Intern Med. 2003;163(8):949-957.
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