People using strong painkillers, opioids, have twice the risk of hip fracture compared to non-opioid users, a study from the University of Eastern Finland shows. The risk was highest in the first two months of opioid use.
The risk of hip fracture increased with increasing opioid strength. Use of weak opioids, such as codeine and tramadol, was not associated with the risk of hip fracture. However, moderately strong opioids, such as buprenorphine, were associated with a two-fold risk, and strong opioids, such as oxycodone and fentanyl, were associated with almost a three-fold risk, compared with non-use. Buprenorphine and fentanyl were almost solely used as patches in this study.
Opioids are used for the treatment of severe pain in cases where other painkillers fail to produce a sufficient response. Opioids impact on the central nervous system and for this reason, opioid use may cause attentional impairment or drowsiness. Opioids are known to increase the risk of falls which, in turn, may lead to hip fracture in older people.
The study was based on the nationwide register-based MEDALZ study conducted at the University of Eastern Finland. For this study, 23,100 community-dwelling persons diagnosed with Alzheimer’s disease in Finland during 2010-2011 were included. From this sample, new opioid users were identified and matched with opioid non-users.
Abstract
The objective of this study was to investigate whether incident opioid use is associated with an increased risk of hip fractures among community-dwelling persons with Alzheimer disease (AD) and to assess the association in terms of duration of use and opioid strength. Among community-dwelling persons with AD diagnosed in 2010 to 2011 (N = 23,100), a matched cohort study comparing incident opioid users (N = 4750) with opioid nonusers (N = 4750) was constructed. Matching was based on age, sex, and time since AD diagnosis at opioid initiation. Data on drug use and hip fractures were retrieved from nationwide registers. Incident opioid users were identified with a 1-year washout. Cox proportional hazard models compared the risk of hip fracture between opioid use and non-use, and were weighted with inverse probability of treatment (IPT), based on a propensity score. Age-adjusted incidence rate of hip fractures was 3.47 (95% confidence interval [CI] 2.62-4.33) during opioid use and 1.94 (95% CI 1.65-2.22) during non-use. Opioid use was associated with an increased risk of hip fracture (IPT-weighted hazard ratio [HR] 1.96, 95% CI 1.27-3.02). The risk was observed during the first 2 months of use (IPT-weighted HR 2.37, 1.04-5.41) and attenuated after that. The results suggest an increase in the risk of hip fracture by increasing opioid strength; weak opioids IPT-weighted HR 1.75 (0.91-3.35), buprenorphine IPT-weighted HR 2.10 (1.41-3.13), and strong opioids IPT-weighted HR 2.89 (1.32-6.32). Further research is needed to find out whether the risk of injurious falls is avoidable by slow titration of opioid doses in the beginning of treatment.
Authors
Taipale H, Hamina A, Karttunen N, Koponen M, Tanskanen A, Tiihonen J, Hartikainen S, Tolppanen AM
[link url="http://www.uef.fi/-/vahvojen-kipulaakkeiden-kaytto-lisaa-lonkkamurtuman-riskia-alzheimerin-tautia-sairastavilla?inheritRedirect=true&redirect=%2Fen%2Fetusivu"]University of Eastern Finland material[/link]
[link url="https://journals.lww.com/pain/Abstract/publishahead/Incident_opioid_use_and_risk_of_hip_fracture_among.98840.aspx"]Pain abstract[/link]