Decreased bone density in men on methadone maintenance therapy.
OBJECTIVE
Opioid use may impact adversely upon skeletal health. Participants in methadone maintenance programmes commonly have prolonged exposure to opioids. We sought to determine whether participants in a methadone maintenance programme have evidence of altered bone mineral density (BMD) and bone turnover.


METHODS
Cross-sectional study of people taking methadone maintenance therapy (MMT).


METHODS
Clinical research centre.


METHODS
Eighty-three people (48 men, 35 women) who had taken MMT for a median (interquartile range) of 11 (6-16) years. Comparison data were from both a normative database and control subjects recruited and assessed at the same location as the participants taking MMT.


METHODS
BMD at lumbar spine, total hip and total body; biochemical markers of bone turnover.


RESULTS
In men taking MMT, BMD was lower than normal at each skeletal site [mean, 95% confidence interval Z-score -1.1 (-1.6 to -0.7) at the lumbar spine, -1.0 (-1.3 to -0.7) at the total hip, and -1.1 (-1.4 to -0.8) at the total body, P < 0.001 at each site]. BMD in the women taking MMT was not different from control values. Bone turnover was within the normal range in both genders. Serum testosterone was lower in the men taking MMT than in controls.


CONCLUSIONS
BMD is lower than normal throughout the skeleton in men, but not women, taking MMT. Assessment of skeletal health, including estimation of absolute fracture risk, should be undertaken in men participating in methadone maintenance programmes.
Department of Medicine, University of Auckland, Auckland, New Zealand. a.grey@auckland.ac.nz
Andrew
A
Grey
Karla
K
Rix-Trott
Anne
A
Horne
Greg
G
Gamble
Mark
M
Bolland
Ian R
IR
Reid
D015502:Absorptiometry, Photon; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000187:drug effects*; D016723:Bone Remodeling / Q000187:drug effects*; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000378:metabolism; D035061:Control Groups; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D006801:Humans; D008297:Male; D008691:Methadone; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000009:adverse effects*; D009293:Opioid-Related Disorders / Q000378:metabolism / Q000534:rehabilitation*; D015675:Osteocalcin / Q000378:metabolism; D010024:Osteoporosis / Q000378:metabolism; D012307:Risk Factors; D012737:Sex Factors; D013739:Testosterone / Q000097:blood
D015415:Biomarkers; D015675:Osteocalcin; D013739:Testosterone; D008691:Methadone