title: Bisphosphonate treatment may reduce osteoporosis risk in female cancer patients with morphine use: a population-based nested case-control study.
abstract: Chronic use of morphine is a risk factor for endocrinopathy and osteoporosis. Bisphosphonates accentuated the protective effect to develop osteoporosis in female patients with malignancy with morphine treatment.
  
  
  BACKGROUND
  This study investigates the risk of osteoporosis associated with morphine use by comparing the incidence of osteoporosis in female cancer patients treated with and without morphine.
  
  
  METHODS
  A population-based nested case-control retrospective analysis was performed using the Longitudinal Health Insurance Database 2000 and Registry for Catastrophic Illness Patients of Taiwan. A malignancy cohort of 12,467 female patients without a history of osteoporosis during 1998-2010, and then 639 patients who subsequently developed osteoporosis as the osteoporosis group, were evaluated. Control-group patients were selected from the malignancy cohort without osteoporosis and frequency matched to each osteoporosis case 2:1 for age, year of cancer diagnosis, and index year. Logistic regression was used to estimate the odds ratios and 95% confidence intervals, and the multivariable model was applied to control for age.
  
  
  RESULTS
  Female cancer patients who received morphine had a 10% lower risk of developing osteoporosis than non-morphine users, but this risk reduction was not significant. For patients treated with bisphosphonates, the morphine group had significantly lower odds in developing osteoporosis than the non-morphine group.
  
  
  CONCLUSIONS
  Morphine treatment is not associated with the incidence of osteoporosis, and bisphosphonates accentuated the protective effect of morphine in the development of osteoporosis in female patients with malignancy in Taiwan.
authors.affiliation: Center for Drug Abuse and Addiction, China Medical University Hospital, Taichung, Taiwan, Republic of China.
authors.forename: C W-S
authors.initials: CW
authors.lastname: Lee
authors.forename: C-H
authors.initials: CH
authors.lastname: Muo
authors.forename: J-A
authors.initials: JA
authors.lastname: Liang
authors.forename: S-N
authors.initials: SN
authors.lastname: Chang
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Chang
authors.forename: C-H
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D004164:Diphosphonates / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D010024:Osteoporosis / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D059408:Pain Management / Q000009:adverse effects / Q000379:methods; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D009020:Morphine