title: Bone mineral density and its determinants in men with opioid dependence.
abstract: Data on the influence of opioid substitution therapy (OST) on skeletal health in men is limited. This cross-sectional study aimed to determine the prevalence of low bone mass in male drug users and to evaluate the relationship between endogenous testosterone and bone mass. We recruited 144 men on long-term opioid maintenance therapy followed in the Center of Addiction Medicine in Basel, Switzerland. Data on medical and drug history, fracture risk and history of falls were collected. Bone mineral density (BMD) was evaluated by densitometry and serum was collected for measurements of gonadal hormones and bone markers. 35 healthy age- and BMI-matched men served as the control group. The study participants received OST with methadone (69 %), morphine (25 %) or buprenorphine (6 %). Overall, 74.3 % of men had low bone mass, with comparable bone mass irrespective of OST type. In older men (≥40 years, n = 106), 29.2 % of individuals were osteoporotic (mean T-score -3.0 ± 0.4 SD) and 48.1 % were diagnosed with osteopenia (mean T-score -1.7 ± 0.4 SD). In younger men (n = 38), 65.8 % of men had low bone mass. In all age groups, BMD was significantly lower than in age-and BMI-matched controls. In multivariate analyses, serum free testosterone (fT) was significantly associated with low BMD at the lumbar spine (p = 0.02), but not at the hip. When analysed by quartiles of fT, lumbar spine BMD decreased progressively with decreasing testosterone levels. We conclude that low bone mass is highly prevalent in middle-aged men on long-term opioid dependency, a finding which may partly be determined by partial androgen deficiency.
authors.affiliation: Basel Center for Addiction Medicine, Basel, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Gotthardt
authors.affiliation: Basel Center for Addiction Medicine, Basel, Switzerland.
authors.forename: Christine
authors.initials: C
authors.lastname: Huber
authors.affiliation: Basel Center for Addiction Medicine, Basel, Switzerland.
authors.forename: Clara
authors.initials: C
authors.lastname: Thierfelder
authors.affiliation: Biostatistics Unit, Swiss Tropical and Public Health Institute Basel, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Leticia
authors.initials: L
authors.lastname: Grize
authors.affiliation: Division of Endocrinology, Diabetology and Metabolism, University Hospital, Missionsstrasse 24, 4055, Basel, Switzerland.
authors.forename: Marius
authors.initials: M
authors.lastname: Kraenzlin
authors.affiliation: Basel Center for Addiction Medicine, Basel, Switzerland.
authors.forename: Claude
authors.initials: C
authors.lastname: Scheidegger
authors.affiliation: Division of Endocrinology, Diabetology and Metabolism, University Hospital, Missionsstrasse 24, 4055, Basel, Switzerland. christian.meier@unibas.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Meier
mesh_terms: D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000187:drug effects*; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000139:chemically induced; D050723:Fractures, Bone / Q000097:blood / Q000139:chemically induced / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000097:blood / Q000150:complications / Q000188:drug therapy; D010024:Osteoporosis / Q000097:blood / Q000139:chemically induced; D013557:Switzerland
chemical_list: D015415:Biomarkers
keywords: Bone mineral density; Opioid dependence; Osteoporosis; Testosterone