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.研究目的：本研究旨在针对接受鞘内阿片类药物给药（intrathecal opioid delivery）以治疗慢性非癌性疼痛（chronic non-malignant pain）的男性患者队列，探究其下丘脑-垂体-性腺轴（hypothalamic-pituitary-gonadal axis）功能，并分析确诊为性腺功能减退症（hypogonadism）的患者是否合并骨量减少（osteopaenia）及/或骨质疏松症（osteoporosis）。 研究设计：本研究为观察性研究，采用非科研用途常规收集的健康数据开展分析。 研究场景：英国达德利市拉塞尔豪尔医院疼痛管理科。 研究对象：连续纳入20名因鞘内阿片类药物治疗随访就诊的男性患者，通过检测其血清黄体生成素（luteinising hormone）、卵泡刺激素（follicle stimulating hormone）、总睾酮（total testosterone）、性激素结合球蛋白（sex hormone binding globulin）水平，并计算游离睾酮（free testosterone）水平以评估性腺轴功能。对确诊为性腺功能减退症的患者，采用双能X线吸收法扫描（DEXA scanning）检测其骨密度。 研究结果：基于计算得到的游离睾酮浓度，17名（85%）患者存在生化性性腺功能减退症，其中15名（75%）患者游离睾酮水平＜180pmol/L，2名（10%）患者游离睾酮水平介于180~250pmol/L。排除3名患者后，对剩余17名中的14名患者进行了骨密度评估。3名（21.4%）患者检出骨质疏松症（定义为T值≤-2.5标准差（standard deviation，SD）），7名（50%）患者检出骨量减少（定义为T值介于-1.0~-2.5标准差之间）。14名患者中有5名（35.7%）髋部骨折干预阈值达标或高于该阈值。 研究结论：本研究提示，接受鞘内阿片类药物治疗慢性非癌性疼痛的患者中，性腺功能减退症与低骨密度存在相关性。对该类患者开展性腺功能减退症及骨密度监测，并予以恰当治疗，对于降低骨质疏松症发生风险、预防骨折或具有至关重要的意义。