Bone mineral density in subjects using central nervous system-active medications
Open accessAbstract
Purpose Decreased bone mineral density defines osteoporosis according to the World Health Organization and is an important predictor of future fractures. The use of several types of central nervous system-active drugs, including benzodiazepines, anticonvulsants, antidepressants, and opioids, have all been associated with increased risk of fracture. However, it is unclear whether such an increase in risk is related to an effect of bone mineral density or to other factors, such as increased risk of falls. We sought to examine the relationship between bone mineral density and the use of benzodiazepines, anticonvulsants, antidepressants, and opioids in a representative US population-based sample.Subjects and methods We analyzed data on adults aged 17 years and older from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Total femoral bone mineral density of 7114 male and 7532 female participants was measured by dual-energy x-ray absorptiometry. Multivariable linear regression models were used to quantify the relation between central nervous system medication exposure and total femoral bone mineral density. Models controlled for relevant covariates, including age, sex, and body mass index.Results In linear regression models, significantly reduced bone mineral density was found in subjects taking anticonvulsants (0.92 g/cm2; 95% confidence interval [CI]: 0.89 to 0.94) and opioids (0.92 g/cm2; 95% CI: 0.88 to 0.95) compared with nonusers (0.95 g/cm2; 95% CI: 0.95 to 0.95) after adjusting for several potential confounders. The other central nervous system-active drugs--benzodiazepines or antidepressants--were not associated with significantly reduced bone mineral density.Conclusion In cross-sectional analysis of NHANES III, anticonvulsants and opioids (but not benzodiazepines or antidepressants) were associated with significantly reduced bone mineral density. These findings have implications for fracture-prevention strategies.
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In a cross-sectional analysis of the Third National Health and Nutrition Examination Survey, opioids were associated with significantly reduced BMD after adjustment for several common causes of secondary osteoporosis.
“Last, in a cross-sectional analysis of Third National Health and Nutrition Examination Survey, opioids were associated with significantly reduced BMD after adjustment for several common causes of secondary osteoporosis (240).”
From Exogenous Opioids and the Human Endocrine System: An Endocrine Society Scientific Statement (2024) · cites this paper as [240]
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- Authors
- Kinjo, M., Setoguchi, S., Schneeweiss, S., & Solomon, D. H.
- Affiliations
- Teine Keijinkai Hospital (JP)
- Brigham and Women's Hospital (US)
- Corresponding author
- Kinjo, Mitsuyo
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2005-12
- Volume
- 118
- Issue
- 12
- Pages
- 1414.e7-1414.e12
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2015727362
- Semantic Scholar
- 49f3d231afc1577ad277425aa4db8183e479a962
- Cited by
- 191
- References
- 50
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 7 · 2023: 1 · 2022: 6 · 2021: 3 · 2020: 11 · 2019: 13 · 2018: 11 · 2017: 5 · 2016: 8 · 2015: 11 · 2014: 9 · 2013: 10 · 2012: 13
- FWCI
- 12.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
- Keywords
- bone mineral density, osteoporosis, antiepileptic drugs, opioids, benzodiazepines, antidepressants, femoral bone density, fracture risk, fall risk, NHANES III
- MeSH terms
- Adolescent, Adult, Aged, Anticonvulsants, Antidepressive Agents, Benzodiazepines, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Narcotics, Osteoporosis, Risk Factors, Bone Density, Health Care Surveys
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