Ensrud et al1 controlled for a large variety of factors in establishing the higher fracture frequency among their elderly opiate-consuming women. Their investigation confirms the results of several previous, less comprehensive studies, which they cite.2,3 Discussion by each of these groups of investigators, however, only addresses the potential contribution to this increased fracture risk by the cognitive effects of these analgesics. A variety of observations indicate that the influence of opiates on other organ systems may substantially contribute directly or indirectly to opioid-associated bone fractures.
Daniell HW. Opioid Osteoporosis. Arch Intern Med. 2004;164(3):338. doi:10.1001/archinte.164.3.338-a