Pain Medications Can Weaken Bones

Christina Lasich, MD Health Pro May 23, 2011
  • You might know someone who is dependent on pain pills. With so many people relying on medications to control chronic painful conditions, everyone should know about the potential long term consequences caused by these medications. Most know about the tendency for anti-inflammatory medications like ibuprofen to cause bleeding stomach ulcers. Some know that too much acetaminophen can harm the liver.   But, did you know that the opioid medications like morphine, oxycodone and hydrocodone can weaken the bones? Besides the unrelenting pain; now someone who is dependent on opioid medications has to worry about the risk of developing a painful fracture as a result of taking pain medications. A bone fracture would add even more pain to an already painful condition. Yikes, you or someone you know needs why opioids can weaken bones and how to avoid opioid-associated osteoporosis.

     

    The reason why chronic, daily opioid use can lead to osteoporosis is twofold. First, the natural production of certain hormones like testosterone is suppressed when someone is taking chemicals like morphine on a routine, daily basis. When too little testosterone is circulating, this condition is called hypogonadism. Not only does hypogonadism cause low libido, fatigued and depression; hypogonadism can also weaken the bones. Although this can affect both men and women, men are particularly at higher risk for developing opioid-associated osteoporosis. For this reason, men who take have used opioids for a long period of time should be on the lookout for symptoms of hypogonadism. These symptoms can alert someone to the silent danger of weakening bones. The second manner in which chronic opioid use can weaken the bones is by directly interfering with bone production. The cells that make bone, the osteoblasts, do not work very well when someone is using opioids routinely. Between waning hormonal levels and sluggish bone production, one-two punch delivered by pain pills can literally punch holes into the bone, creating a serious case of osteoporosis.

     

    In order to help you or someone you know avoid opioid osteoporosis, some precautions should be discussed. First of all, the testosterone level needs to be checked. Although a low total testosterone level is associated with osteoporosis, it is not a prerequisite. In one study, nearly half of those taking opioids had a normal testosterone level yet still had osteopenia or osteoporosis. So, testosterone monitoring is not enough. Routine bone mass screening with a DEXA scan is also recommended. With both testosterone level monitoring and bone density screening, the likelihood of detecting opioid-associated osteoporosis is good. And once detected, the weakening bone can be treated and a fracture can hopefully be avoided.

     

    Speaking of fracture prevention, many elderly people are taking prescription pain pills which put them at greater risk of falls. These chemicals cause dizziness, drowsiness, and confusion sometimes. In these situations, fall prevention is extremely important especially when pain pills are also weakening bones. By clearing the walking pathways, using an assistive devices, or avoiding poorly lit conditions, the devastating falls and resulting bone fractures can be prevented.

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    With so many people using opioids to control pain, you probably know someone who is at risk for developing opioid-associated osteoporosis. Risk assessment is extremely important and includes: monitoring testosterone levels and bone density routinely in those taking pain pills. The potential for weakening bones can then be detected and treated accordingly. Despite the potential consequences, these pain medications can be worth the risks. At other times, they are not. If you know someone who is taking opioid pain medications, let him/her know about the potential for opioids to weaken the bones.  

     

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