The unsolved case of “bone-impairing analgesics”: The endocrine effects of opioids on bone metabolism

Flaminia Coluzzi, Joseph Pergolizzi, Robert B. Raffa, Consalvo Mattia

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


The current literature describes the possible risks for bone fracture in chronic analgesics users. There are three main hypotheses that could explain the increased risk of fracture associated with central analgesics, such as opioids: 1) the increased risk of falls caused by central nervous system effects, including sedation and dizziness; 2) reduced bone mass density caused by the direct opioid effect on osteoblasts; and 3) chronic opioid-induced hypogonadism. The impact of opioids varies by sex and among the type of opioid used (less, for example, for tapentadol and buprenorphine). Opioid-associated androgen defciency is correlated with an increased risk of osteoporosis; thus, despite that standards have not been established for monitoring and treating opioid-induced hypogonadism or hypoadrenalism, all patients chronically taking opioids (particularly at doses $100 mg morphine daily) should be monitored for the early detection of hormonal impairment and low bone mass density.

Original languageEnglish (US)
Pages (from-to)515-523
Number of pages9
JournalTherapeutics and Clinical Risk Management
StatePublished - Mar 31 2015


  • Bone metabolism
  • Chronic pain
  • Endocrine system
  • Fractures
  • Opioids side effects

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Medicine(all)
  • Pharmacology, Toxicology and Pharmaceutics(all)
  • Safety Research
  • Chemical Health and Safety


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