Decreased bone density in men on methadone maintenance therapy

Aims Opioid use may impact adversely upon skeletal health. Participants in methadone maintenance programmes commonly have prolonged exposure to opioids. We sought to determine whether participants in a methadone maintenance programme have evidence of altered bone mineral density (BMD) and bone turnover. Design Cross-sectional study of people taking methadone maintenance therapy (MMT). Setting Clinical research centre. Participants Eighty-three people (48 men, 35 women) who had taken MMT for a median (interquartile range) of 11 (6-16) years. Comparison data were from both a normative database and control subjects recruited and assessed at the same location as the participants taking MMT. Measurements BMD at lumbar spine, total hip and total body; biochemical markers of bone turnover. Findings In men taking MMT, BMD was lower than normal at each skeletal site [mean, 95% confidence interval Z-score -1.1 (-1.6 to -0.7) at the lumbar spine, -1.0 (-1.3 to -0.7) at the total hip, and -1.1 (-1.4 to -0.8) at the total body, P < 0.001 at each site]. BMD in the women taking MMT was not different from control values. Bone turnover was within the normal range in both genders. Serum testosterone was lower in the men taking MMT than in controls. Conclusions BMD is lower than normal throughout the skeleton in men, but not women, taking MMT. Assessment of skeletal health, including estimation of absolute fracture risk, should be undertaken in men participating in methadone maintenance programmes.