Data from: Hypogonadism and low bone mineral density in patients on long-term intrathecal opioid delivery therapy

Objectives: This study aimed to investigate the
hypothalamic-pituitary-gonadal axis in a sample of male patients
undertaking intrathecal opioid delivery for the management of chronic
non-malignant pain and the presence of osteopaenia and/or osteoporosis in
those diagnosed with hypogonadism. Design: Observational study using
health data routinely collected for non-research purposes. Setting:
Department of Pain Management, Russells Hall Hospital, Dudley, UK.
Patients: Twenty consecutive male patients attending follow-up clinics for
intrathecal opioid therapy had the gonadal axis evaluated by measuring
their serum luteinising hormone, follicle stimulating hormone, total
testosterone, sex hormone binding globulin and calculating the free
testosterone level. Bone mineral density was measured by DEXA scanning in
those patients diagnosed with hypogonadism. Results: Based on the
calculated free testosterone concentrations, 17 (85%) patients had
biochemical hypogonadism with 15 patients (75%) having free testosterone
<180 pmol/L and 2 patients (10%) between 180 and 250 pmol/L. Bone
mineral density was assessed in 14 of the 17 patients after the exclusion
of 3 patients. Osteoporosis (defined as a T score ≤−2.5 SD) was detected
in three patients (21.4%) and osteopaenia (defined as a T score between
−1.0 and −2.5 SD) was observed in seven patients (50%). Five of the 14
patients (35.7%) were at or above the intervention threshold for hip
fracture. Conclusions: This study suggests an association between
hypogonadism and low bone mass density in patients undertaking intrathecal
opioid delivery for the management of chronic non-malignant pain.
Surveillance of hypogonadism and the bone mineral density levels followed
by appropriate treatment may be of paramount importance to reduce the risk
of osteoporosis development and prevention of fractures in this group of
patients.