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Patients on injectable diacetylmorphine maintenance have low bone mass


Kenneth M. Dürsteler-MacFarland Lic Phil/MA, Clinical and Research Psychologist, Roland Kowalewski MD, Consultant Psychiatrist, Nicole Bloch Lic Phil, Research Psychologist, Gerhard A. Wiesbeck MD, Consultant Psychiatrist, Head of Division, Marius E. Kraenzlin MD, Consultant Physician in Endocrinology, Rudolf Stohler MD, Consultant Psychiatrist, Head of Division. Mr Kenneth M. Dürsteler-MacFarland, Division of Substance Use Disorders, Psychiatric Hospital of the University of Basel, Wilhelm Klein-Strasse 27, CH-4012 Basel, Switzerland. Tel: +41 61 325 5125; Fax: +41 61 325 5364; E-mail:


Introduction and Aims.Risk factors for osteoporosis are prevalent in chronic heroin users who often start using opiates in their late teens. This study was the first to evaluate bone mineral density (BMD) in relatively young heroin-dependent patients on injectable heroin maintenance.

Design and Methods.Using cross-sectional design, BMD was assessed in a convenience sample of 19 patients (mean age ± SD = 33.9 ± 5.4; 13 men) prescribed injectable diacetylmorphine for heroin dependence. BMD of the lumbar spine and proximal femur was measured by dual-energy X-ray absorptiometry. Substance use and menstrual history, psychopathology and risk factors for low BMD were assessed by questionnaire-based interviews.

Results.According to World Health Organisation criteria almost three-quarters (74%) of the sample had osteopenia (n = 11) or osteoporosis (n = 3) at one or more sites of measurement. All patients showed multiple risk factors for bone loss, with pack-years of tobacco use and years of heroin use reaching marginally significant associations with spine Z-scores. Moreover, BMD Z-scores correlated significantly negatively with increasing age at all sites, indicating that the older the patient, the greater the BMD deviation from an age-controlled population.

Discussion and Conclusions.Prolonged heroin dependence appears to be associated with lower-than-normal bone mass already at early age and these individuals might be at greater risk for fracture with advancing age. The negative correlation of age-adjusted Z-scores with increasing age suggests factors other than age for low BMD in this population (e.g. smoking, heroin use). Prospective studies are warranted to determine the necessity for diagnostic and preventive measures.[Dürsteler-MacFarland KM, Kowalewski R, Bloch N, Wiesbeck GA, Kraenzlin ME, Stohler R. Patients on injectable diacetylmorphine maintenance have low bone mass. Drug Alcohol Rev 2010;30:577–582]