Int J Med Sci 2021; 18(2):575-581. doi:10.7150/ijms.52201 This issue

Research Paper

Factors Associated with Low Bone Density in Opioid Substitution Therapy Patients: A Systematic Review

Fitri Fareez Ramli1✉, Syed Alhafiz Syed Hashim1, Nadia Mohd Effendy2

1. Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia.
2. Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Persiaran Ilmu, Bandar Baru Nilai, 71800 Nilai, Negeri Sembilan, Malaysia.

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Ramli FF, Syed Hashim SA, Mohd Effendy N. Factors Associated with Low Bone Density in Opioid Substitution Therapy Patients: A Systematic Review. Int J Med Sci 2021; 18(2):575-581. doi:10.7150/ijms.52201. Available from

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Background: Long-term opioid therapy is a risk factor for low bone mineral density (BMD). However, other factors may also contribute to low BMD. Several studies have examined the variables that might contribute to low BMD in patients receiving opioid replacement therapy (OST). However, to our knowledge, there was no systemic review conducted to address this particular issue. Thus, we reviewed the articles on the factors associated with low BMD in the population of opioid use disorder receiving substitution therapy.

Methods: The articles that examined correlates or risk factors of low BMD in OST population were retrieved from OVID, SCOPUS, and PUBMED from inception until July 2020 by two independent investigators.

Results: A total of 429 articles from three databases were retrieved initially. After screening based on eligibility criteria, five articles were included in the final analysis. The risk factors or correlates found to be significantly associated with low BMD in the OST population include male gender, low body mass index, low testosterone level, methadone or heroin use, and longer duration of heavy alcohol use. The review limitations include small sample sizes and inconsistent definition of variables.

Conclusion: OST patients should be screened for BMD and its associated factors. Guidelines and training of practitioners involving in the OST service should be provided to increase the detection of low BMD in the OST population.

Keywords: Opioid, Methadone, Buprenorphine, Bone mineral density, Bone mass