Opioid Analgesics and the Risk of Fractures in Older Adults with Arthritis

• Autores: Matthew Miller, Til Stürmer, Deborah Azrael, Raisa Levin, Daniel H. Solomon
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 59, Nº. 3, 2011, págs. 430-438
• Idioma: inglés
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• Resumen

  • OBJECTIVES: To compare the risk of fracture associated with initiating opioids with that of nonsteroidal anti-inflammatory drugs (NSAIDs) and the variation in risk according to opioid dose, duration of action, and duration of use.

    DESIGN: Retrospective cohort study.

    SETTING: Two statewide pharmaceutical benefit programs for persons aged 65 and older.

    PARTICIPANTS: Twelve thousand four hundred thirty-six initiators of opioids and 4,874 initiators of NSAIDs began treatment between January 1, 1999, and December 31, 2006. Mean age at initiation of analgesia was 81; 85% of participants were female, and all had arthritis.

    MEASUREMENTS: Cox proportional hazards models, adjusted for several potential confounders, quantified fracture risk. Study outcomes were fractures of the hip, humerus or ulna, or wrist, identified using a combination of diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification) and procedure (Common Procedural Terminology) codes.

    RESULTS: There were 587 fracture events among the participants initiating opioids (120 fractures per 1,000 person-years) and 38 fracture events among participants initiating NSAIDs (25 fractures per 1,000 person-years) (hazard ratio (HR)=4.9, 95% confidence interval (CI)=3.5�6.9). Fracture risk was greater with higher opioid dose. Risk was greater for short-acting opioids (HR=5.1, 95% CI=3.7�7.1) than for long-acting opioids (HR=2.6, 95% CI=1.5�4.4), even in participants taking equianalgesic doses, with differential fracture risk apparent for the first 2 weeks after starting opioids but not thereafter.

    CONCLUSION: Older people with arthritis who initiate therapy with opioids are more likely to experience a fracture than those who initiate NSAIDs. For the first 2 weeks after initiating opioid therapy, but not thereafter, short-acting opioids are associated with a greater risk of fracture than are long-acting opioids.