NATAP: Opiods & Bone Loss

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This is not new.....Opioid Use & Bone Loss: Prospective study of bone mineral density changes in aging men with or at risk for HIV infection - (08/29/10)"heroin users with AIDS may be at particular

risk for bone loss.....these data suggest that HIV-infected opioid-using men may be at particular risk of bone loss as they age, as a

result of comorbid disease such as hepatitis C infection, opioid substitution treatment with methadone, ongoing heroin use, progression to AIDS, or a combination of these factors." AIDS: POST AUTHOR CORRECTIONS, Epub 30 July 2010Opioids may contribute to lowered BMD by directly interfering with bone formation. Studies [26,27] have documented large concentrations of opioid receptors in osteoblasts; inhibition of the growth of human osteoblast tissue cultures by small concentrations of opioids [26]; prevention of this inhibition by opioid antagonists [26]; lowered serum levels of osteocalcin, a bone formation marker, in heroin addicts [28]; and inhibition of osteocalcin production by morphine in osteoblast tissue cultures, which was abolished when osteoblastic cells were incubated simultaneously with naloxone [27]. An effect of opiates on calcium-regulating hormones has also been reported, in addition to other

mechanisms relating to altered bone metabolism. these data suggest that HIV-infected opioid-using men may be at particular risk of bone loss as they age, as a

result of comorbid disease such as hepatitis C infection, opioid substitution treatment with methadone, ongoing heroin use, progression to AIDS, or a combination of these factors.Like HIV-infected individuals, opioid users possess multiple risk factors for osteopenia, including hypogonadism, tobacco use, alcohol use, lack of physical activity, and malnutrition. Yet BMD in patients with opioid dependence has received limited attention. Prescription opioid users had reduced total hip BMD compared with nonusers in the third National Health and Nutrition Examination Survey ,

with a nonsignificant trend toward longer term opioid users having lower BMD than shorter term users. Data on illicit opioid use were not available in that study [15]. A cross-sectional study [16] in a methadone maintenance treatment program found that more than three quarters of the patients met the WHO criteria for osteoporosis or osteopenia despite a median age of only 42 years, including an unexpectedly high proportion of the 33 men studied having osteopenia (36%) and osteoporosis (61%). Many participants had risk factors for osteoporosis including history of tobacco use (95%), heavy alcohol use (52%), persistent amenorrhea (32% of women), and HIV infection (28%), which likely contributed to the high prevalence of low BMD.....