McMaster Textbook of Internal Medicine

Opioids and osteoporosis

2018-10-19

Alexandra Papaioannou

Recorded at the 4th McMaster International Review Course in Internal Medicine (MIRCIM).

Is osteoporosis caused by long-term use of strong opioids a significant clinical problem?

Alexandra Papaioannou, MD: The question is, are opioids associated with osteoporosis? One of the biggest challenges with opioids is that they are one of the leading drugs associated with falls and fractures, regardless of dose. Particularly the higher doses have the highest relative risk for fracture.

As to the long-term use, there is an association but we are not totally clear on the mechanism.

See also

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Initial management in rheumatologic emergencies What should be the initial management in rheumatologic emergencies? Which patients should be transported to the ICU?
Pharmacological treatment in osteoporosis: When to start? When should we start pharmacological treatment of osteoporosis?
Opioids in the treatment of chronic pain A lecture by Dr Jenny Legassie, from McMaster University, Canada, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
Current management of gout A lecture by Dr George Nuki, from University of Edinburgh, UK, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
Extra-articular manifestations in spondyloarthritis A lecture by Dr Filip Van den Bosch, from Ghent University, Belgium, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
Colchicine in acute gout If colchicine in doses 1 g + 0.5 g is partly ineffective in a patient with acute gout, should it be continued at the same daily dose or is it better to switch to or add a nonsteroidal anti-inflammatory drug or a corticosteroid?
Medical opioid controversy. Part 1 Dr Gordon Guyatt, Distinguished Professor at McMaster University Department of Health Research Methods, Evidence, and Impact and one of the founders of evidence-based medicine, discusses new Canadian guidelines on opioid use in chronic noncancer pain.

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