Does opioid use for pain management warrant routine bone mass density screening in men?

Although opioids are known to inhibit testosterone production and bone formation, no prior study has investigated the relationship between opioid use in male subjects and bone mass density measurements.

Eighty-one male patients who had been using opioids for a period of time from a few weeks to 20 years were included in this study. Blood samples were obtained to examine the total testosterone level of these subjects and each patient also had a bone mass density scan. This study was done retrospectively using lab values collected during the normal care of the patient. No extra measures were done relative to this study and all patient identifiers were removed from the data prior to analysis. Accordingly, there was no need here for an IRB or patient consent.

Fifty percent of hypogonadal men had bone mass densities in the osteoporotic or osteopenic range. Forty-two percent of the men who had total testosterone levels within the normal range also had bone mass densities within these ranges. Other factors may also influence the bone mass density results. For example, in this study 52% of the patients disclosed that they smoke.

Of this population almost half of the men had bone mass densities in the osteopenic/osteoporotic ranges, regardless of their total testosterone blood level. Therefore, monitoring the total testosterone blood level is not a reliable method to determine the risk for developing opioid-associated osteoporosis. Further investigations should be done to help evaluate whether routine bone mass density screenings for men prescribed opioids for chronic pain management may be warranted.