An updated analysis of opioids increasing the risk of fractures

Abstract

<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>To assess the relationship between opioid therapy for chronic noncancer pain and fracture risk by a meta-analysis of cohort studies and case-control studies.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The included cohort studies and case-control studies were identified by searching the PubMed and EMBASE databases from their inception until May 24, 2019. The outcome of interest was a fracture. This information was independently screened by two authors. When the heterogeneity among studies was significant, a random effects model was used to determine the overall combined risk estimate.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In total, 12 cohort studies and 6 case-control studies were included. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of the included literature, and 14 of the studies were considered high-quality studies. The overall relative risk of opioid therapy and fractures was 1.78 (95% confidence interval (CI) 1.53 - 2.07). Subgroup analyses revealed sources of heterogeneity, sensitivity analysis was stable, and no publication bias was observed.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The meta-analysis showed that the use of opioids significantly increased the risk of fracture.</jats:p></jats:sec>

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

“…The prevalence of suspected medication-related falls is about 41% [ 555 ] to 49% [ 556 ]. Increased risk of falls was documented in users of anxiolytics/hypnotics, opioids, sedatives, antihypertensives (especially alpha-blockers), antidepressants, antiparkinsonian medications, antiepileptics and antiarrhythmics [ 557 , 558 , 559 , 560 , 561 , 562 , 563 , 564 , 565 , 566 , 567 , 568 , 569 , 570 , 571 , 572 , 573 , 574 , 575 , 576 , 577 , 578 , 579 , 580 , 581 , 582 , 583 ]; polypharmacy is strongly associated with injurious falls and fractures [ 574 , 582 , 584 , 585 , 586 , 587 , 588 ].…”

Review of publications evaluating opioid use in patients with inflammatory rheumatic disease

“…Among patients with RA, opioid use has been associated with increased risk of fracture (adjusted hazard ratio [aHR] 1.37 [95% CI 1.18-1.59] for weak opiates, aHR 1.53 [95% CI 1.24-1.88] for strong opiates) [19]. Increased fracture risk from opioids may be a result of cognitive side effects, more falls, or opioidinduced endocrinopathies [20][21] as identified in other patient populations. Recent evidence also demonstrates that hospitalizations for RA patients have a higher risk of primary diagnosis of opioid poisoning compared to the general population [22], emphasizing that the risks of adverse outcomes from opioids may be magnified in RA patients.…”