Opioids May Harm Reproductive, Bone, Adrenal Hormone Health

TOPLINE:

Opioid use has multiple negative effects on the endocrine system and can lead to reproductive, bone, and adrenal hormone health complications, reported a scientific statement.

METHODOLOGY:

• The scientific statement was developed by a task force appointed by the Endocrine Society, with internal review by the relevant society committees and expert external reviewers prior to a comment period open to all members of the society.
• The authors reviewed recent research on the clinical consequences of opioid use, especially on the hypothalamic-pituitary system and bone health.
• The resulting statement addressed many of the research gaps associated with opioids’ effects on the endocrine system, with each section presenting available data on diagnostic and management approaches for opioid-endocrine sequelae.

TAKEAWAY:

• Opioids inhibit the hypothalamic-pituitary-adrenal axis as well as the hypothalamic-pituitary-gonadal axis and can cause hypogonadism.
• Acute administration of opioids increases prolactin secretion, and chronic use can lead to hyperprolactinemia.
• Evidence of opioid actions on oxytocin derived from studies on women in labor suggests an inhibitory effect (opioids can inhibit plasma oxytocin levels during labor).
• Opioid use can have a negative impact on bone homeostasis and metabolism; reduced bone mineral density and increased risk for fracture have been reported; proposed implicated mechanisms for these negative sequelae include direct effects on bone remodeling, increased risk for falls, and hypogonadism.

IN PRACTICE:

“Clinicians need to be aware of these endocrine health consequences and monitor patients who are using opioids more closely for signs and symptoms of them,” lead author said in a statement.

SOURCE:

The scientific statement was published online on October 23 in Endocrine Reviews, with Niki Karavitaki, PhD, of the University of Birmingham, Birmingham Health Partners, and the University Hospitals, all in Birmingham, England, as lead author.

LIMITATIONS:

This scientific statement “highlights a plethora of gaps in research associated with the effects and clinical consequences of opioids on the endocrine system [and] is not intended to serve as a guideline or dictate treatment decisions,” the authors stated.

DISCLOSURES:

The authors did not receive funding support from any organization for the submitted work. Karavitaki reported being a speaker for Pfizer, Ipsen, HRA Pharma, Recordati Rare Diseases, and Consilient Health; an investigator for Pfizer, Ipsen, and Shire; and a scientific advisory board member for Pfizer, Ipsen, and Recordati Rare Diseases. Four other coauthors also received fees from industry.