214602 Opioid analgesic use and the risk of fractures among older adults

Tuesday, November 9, 2010 : 2:50 PM - 3:10 PM

Matthew Miller, MD, ScD , Harvard School of Public Health, Boston, MA
Til Sturmer, MD , Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, Chapel Hill, NC
Deborah Azrael, PhD , Harvard School of Public Health, Boston, MA
Raisa Levin , Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, Boston, MA
Daniel H. Solomon, MD, MPH , Division of Pharmacoepidemiology, Harvard University, Brigham and Women's Hospital, Boston, MA
  
Background: Few studies have assessed the risk of fractures among older adults initiating treatment with opioid analgesics. None have quantified the variation in fracture risk by duration of opioid action.

Methods: We assembled a cohort of Medicare beneficiaries with arthritis who initiated opioids and identified subsequent non-vertebral fractures. Incidence rates and adjusted hazard ratios (HR) for opioid users were compared with subjects initiating non-selective non-steroidal anti-inflammatory drugs (NSAIDs). Covariates included in all models included age, gender, race, and comorbidities associated with falls and fractures.

Results: The average age of participants was 81 years, 85% were female, 90% had OA and the rest RA. 12,436 patients began monotherapy with an opioid analgesic; 4,874 with an NSAID. Compared with patients initiating NSAIDs, opioid users were more likely to suffer a fracture (HR 4.9, 95% CI 3.5 -- 6.9). Higher doses of opioids were associated with higher fracture risk. The relative risk of fracture was higher among users of short-acting opioids (HR=5.1, 95% CI 3.7 -- 7.1) than among users of long-acting opioids (HR=2.6, 95% CI 1.5 -- 4.4). Among high-dose opioid users, patients who initiated short-acting opioids were twice as likely to suffer a fracture, compared with patients taking equianalgesic doses of long-acting opioids (HR=2.1, 95% CI 1.3-- 3.5).

Conclusions: Older patients with arthritis who initiate analgesic medication with opioids are more likely to suffer a fracture compared with patients who initiate an NSAID. Use of short-acting agents is associated with twice the risk of fracture, compared with use of long-acting agents.

Learning Objectives:
1. Describe the risk of fractures among older adults starting opioid vs. non-opioid analgesic therapy 2. Compare the risk of fracture among older adults starting long-acting vs. short-acting opioid analgesics 3. Discuss the potential sources of confounding that characterize prior work and the way the current study attempts to mitigate these potential biases. 4. Identify what this study adds to prior knowledge about the relationship between opioid use and fracture risk among older adults.

Keywords: Epidemiology, Injury Prevention

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was primarily resp0nsible for the design, writing, and synthesis of the study
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4284.0: Injuries among older adults