Faculty of Health, Birmingham City University, Birmingham, UK.
BMJ Open. 2013 Jun 20;3(6):e002856. doi: 10.1136/bmjopen-2013-002856.
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.
Observational study using health data routinely collected for non-research purposes.
Department of Pain Management, Russells Hall Hospital, Dudley, UK.
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.
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.
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.
本研究旨在调查接受鞘内阿片类药物输注治疗慢性非恶性疼痛的男性患者的下丘脑-垂体-性腺轴，以及在诊断为性腺功能减退症的患者中存在骨质疏松症和/或骨量减少的情况。
使用常规收集的非研究目的的健康数据进行观察性研究。
英国达德利拉塞尔大厅医院疼痛管理科。
20 名连续接受鞘内阿片类药物治疗的男性患者接受了性腺轴评估，方法是测量他们的血清黄体生成素、卵泡刺激素、总睾酮、性激素结合球蛋白，并计算游离睾酮水平。在诊断为性腺功能减退症的患者中，通过 DEXA 扫描测量骨密度。
根据计算的游离睾酮浓度，17 名（85%）患者存在生化性腺功能减退症，其中 15 名（75%）患者的游离睾酮<180 pmol/L，2 名（10%）患者的游离睾酮在 180-250 pmol/L 之间。在排除 3 名患者后，对 17 名患者中的 14 名进行了骨密度评估。在 3 名患者（21.4%）中发现骨质疏松症（定义为 T 评分≤-2.5 SD），在 7 名患者（50%）中发现骨量减少（定义为 T 评分在-1.0 到-2.5 SD 之间）。在 14 名患者中，有 5 名（35.7%）患者的髋部骨折干预阈值或以上。
本研究表明，接受鞘内阿片类药物输注治疗慢性非恶性疼痛的患者中，性腺功能减退症与骨密度降低之间存在关联。对性腺功能减退症和骨矿物质密度水平进行监测，并进行适当的治疗，可能对降低这组患者骨质疏松症发展和骨折风险至关重要。
