To the Editor:
Bone infarcts result, probably, from interruption of bone blood flow due to intraosseous arterial thrombosis or hypertrophy of adipocytic cells1. Bone infarcts (denoted as multifocal when more than 5 sites are involved2) have recently been described in HIV-infected patients3. In this context, a relationship with intravenous drug use has been established by some authors4. Buprenorphine marketed under the trade name Subutex® is prescribed for opioid detoxification and subsequent maintenance therapy. It can be administered sublingually, subcutaneously, or intravenously. We describe 4 patients presenting with multifocal bone infarcts in whom buprenorphine abuse was detected.
Patient 1, a 36-year-old woman, never pregnant, was a former cocaine addict, but stated she had not taken the drug for 6 years. She had since been treated with oral buprenorphine (Subutex) daily. For 2 years, she had experienced day and night pain of the knees, ankles, and feet. Her alcohol consumption was one or 2 glasses per day. Magnetic resonance imaging (MRI) revealed multifocal infarcts of the distal femoral and proximal …
Address correspondence to Prof. M. Laroche, Centre de Rhumatologie, Hopital Purpan, TSA 40031, 31059 Toulouse Cedex 9, France; E-mail:laroche.m{at}chu-toulouse.fr