Patients on injectable diacetylmorphine maintenance have low bone mass.

INTRODUCTION AND AIMS: Risk factors for osteoporosis are prevalent in chronic heroin users who often start using opiates in their late teens. This study was the first to evaluate bone mineral density (BMD) in relatively young heroin-dependent patients on injectable heroin maintenance. DESIGN AND METHODS: Using cross-sectional design, BMD was assessed in a convenience sample of 19 patients (mean age ± SD = 33.9 ± 5.4; 13 men) prescribed injectable diacetylmorphine for heroin dependence. BMD of the lumbar spine and proximal femur was measured by dual-energy X-ray absorptiometry. Substance use and menstrual history, psychopathology and risk factors for low BMD were assessed by questionnaire-based interviews. RESULTS: According to World Health Organisation criteria almost three-quarters (74%) of the sample had osteopenia (n = 11) or osteoporosis (n = 3) at one or more sites of measurement. All patients showed multiple risk factors for bone loss, with pack-years of tobacco use and years of heroin use reaching marginally significant associations with spine Z-scores. Moreover, BMD Z-scores correlated significantly negatively with increasing age at all sites, indicating that the older the patient, the greater the BMD deviation from an age-controlled population. DISCUSSION AND CONCLUSIONS: Prolonged heroin dependence appears to be associated with lower-than-normal bone mass already at early age and these individuals might be at greater risk for fracture with advancing age. The negative correlation of age-adjusted Z-scores with increasing age suggests factors other than age for low BMD in this population (e.g. smoking, heroin use). Prospective studies are warranted to determine the necessity for diagnostic and preventive measures.

Persistent paraplegia after an aqueous 7.5% phenol solution to the anterior motor root for intercostal neurolysis: a case report.

A 55-year-old white man with severe scoliosis and chest deformity was scheduled for an intercostal neurolysis for pain relief with 7.5% aqueous phenol solution. A 20 G needle was inserted 3 to 4cm lateral to the midline of the spine under the 10th right rib. After negative aspiration for blood and alcohol, 6mL of a 7.5% aqueous phenol solution was injected. Within a minute after the injection, the patient felt a warm sensation in his right leg, followed by loss of leg motor and sensory function on both sides. A lumbar puncture done 3.5 hours after the block showed a phenol concentration of 87.5 microg/mL. The most likely explanation is a diffusion of the phenol through the intervertebral foraminae reaching the spinal space and therefore damaging the motor and sensory roots. This case highlights the danger associated with phenol application in the vicinity of the spinal cord.