Incident opioid use and risk of hip fracture among persons with Alzheimer disease: a nationwide matched cohort study

Taipale, Heidi; Hamina, Aleksi; Karttunen, Niina; Koponen, Marjaana; Tanskanen, Antti; Tiihonen, Jari; Hartikainen, Sirpa; Tolppanen, Anna‐Maija

doi:10.1097/j.pain.0000000000001412

Cited by 22 publications

(15 citation statements)

References 30 publications

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“…Using predefined search strategies and inclusion criteria, a total of 18 studies were included and 1,134 articles of unrelated literature were excluded (from a total of 600 articles from PubMed and 552 articles from EMBASE) after a detailed reading of the title, abstract, and full text, and the 18 articles included 884054 participants [3,7,9,19–32]. The detailed process of inclusion in this study is shown in Fig 1.…”

Section: Resultsmentioning

confidence: 99%

“…There was a positive correlation between the use of opioids and fractures (RR 1.78, 95% CI 1.53-2.07) (Fig 2), and we observed significant heterogeneity among the studies. Eleven studies provided data on opioid use and hip fracture risk [3,7,19–23,27,29–31]. Pooled studies showed that the use of opioids had a significant impact on the risk of hip fracture (RR 1.56, 95% CI 1.37-1.79), and there was significant heterogeneity among the studies (P = 0.000, I 2 = 83.1%) (Fig 3); we subsequently revealed the sources of heterogeneity through subgroup analyses.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, there are two main mechanisms for the occurrence of fractures with opioid use. One mechanism is that opioids may reduce bone density by inhibiting the production of endogenous sex hormones, leading to an increased risk of fractures [34]; the other mechanism involves the side effects of opioids, such as the central nervous system side effects of vertigo, fatigue, etc., that lead to the occurrence of fractures [7,9,27,28], and there is a high incidence of side effects, including acute cognitive deterioration, increased sputum production, decreased oxygen saturation, and constipation, after the use of opioids in elderly populations, as confirmed in recent studies [35]. The trend of the population aging is becoming increasingly pronounced, and osteoporosis in this aging population is a serious concern.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, studies have shown that opioid-induced fractures are associated with time of use [5] and are also associated with the use of opioids [6]. Opioids have been linked to the occurrence of fractures [2,3,7–11], and although the use of opioids has been reported to increase the risk of fractures, the trend of using opioids continues to increase [12]. However, in the previous studies, due to the influence of sample size, types of research, etc., there may have been inconsistencies, and we aimed to reconfirm the correlation between opioids and fracture risk while incorporating subsequently published studies.…”

Section: Introductionmentioning

confidence: 99%

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An updated analysis of opioids increasing the risk of fractures

Yue

Teng

et al. 2019

Preprint

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AbstractObjectiveTo assess the relationship between opioid therapy for chronic noncancer pain and fracture risk by a meta-analysis of cohort studies and case-control studies.MethodsThe 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.ResultsIn 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.ConclusionsThe meta-analysis showed that the use of opioids significantly increased the risk of fracture.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

An updated analysis of opioids increasing the risk of fractures

Yue

Teng

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…In addition, studies have shown that opioid-induced fractures are associated with time of use [5] and are also associated with the use of opioids [6]. Opioids have been linked to the occurrence of fractures [2,3,[7][8][9][10][11], and although the use of opioids has been reported to increase the risk of fractures, the trend of using opioids continues to increase [12]. However, in the previous studies, due to the influence of sample size, types of research, etc., there may have been inconsistencies, and we aimed to reconfirm the correlation between opioids and fracture risk while incorporating subsequently published studies.…”

Section: Introductionmentioning

confidence: 99%

An updated analysis of opioids increasing the risk of fractures

Yue

Teng

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

Objective 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. Methods 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. Results 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. Conclusions The meta-analysis showed that the use of opioids significantly increased the risk of fracture.

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Polypharmacy and Potentially Inappropriate Medication Use in Older Adults With Systemic Lupus Erythematosus

Séguin

Peschken

Dolovich

et al. 2022

Arthritis Care & Research

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Objective To assess the prevalence and potential risk factors for polypharmacy and prescribing of the potentially inappropriate medications, opioids and benzodiazepines/Z‐drugs, in older adults with systemic lupus erythematosus (SLE). Methods The study population comprised adults age ≥50 years meeting American College of Rheumatology or Systemic Lupus International Collaborating Clinics classification criteria followed at a tertiary care rheumatology clinic. Information on prescriptions filled in the 4 months preceding chart review was obtained from the Manitoba Drug Program Information Network. Clinical data, including age, sex, Charlson Comorbidity Index (CCI) score, Systemic Lupus Erythematosus Disease Activity Index 2000 score, prednisone use, SLE duration, and rural residence were abstracted from electronic medical records. Logistic regression analyses were performed to assess any association between polypharmacy (using 2 definitions: ≥5 and ≥10 medications), potentially inappropriate medication use, and clinical features. Results A total of 206 patients (mean age 62 years, 91% female, 36% rural) were included: 148 (72%) filled ≥5 medications, 71 (35%) filled ≥10 medications, 63 (31%) used benzodiazepines/Z‐drugs, and 50 (24%) used opioids. Among the 77 patients age ≥65 years, 57 (74%) filled ≥5 medications, and 26 (34%) filled ≥10 medications, compared to 30% and 4%, respectively, of Manitobans age ≥65 years (National Prescription Drug Utilization Information System, 2016). The odds of polypharmacy were greater with prednisone use (adjusted odds ratio [OR] 3.70 [95% confidence interval (95% CI) 1.40–9.79] for ≥5 medications), CCI score (adjusted OR 1.62 [95% CI 1.20–2.17]), and rural residence (adjusted OR 2.05 [95% CI 1.01–4.18]). Odds of benzodiazepine/Z‐drug use were increased with polypharmacy (adjusted OR 4.35 [95% CI 1.69–11.22]), and odds of opioid use were increased with polypharmacy (adjusted OR 6.75 [95% CI 1.93–23.69]) and CCI score (adjusted OR 1.29 [95% CI 1.08–1.54]). Conclusion The prevalence of polypharmacy in this SLE cohort was higher than in the general Manitoban population. Polypharmacy is a strong marker for use of prescription benzodiazepines/Z‐drugs and opioids.

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Incident opioid use and risk of hip fracture among persons with Alzheimer disease: a nationwide matched cohort study

Cited by 22 publications

References 30 publications

An updated analysis of opioids increasing the risk of fractures

An updated analysis of opioids increasing the risk of fractures

An updated analysis of opioids increasing the risk of fractures

Polypharmacy and Potentially Inappropriate Medication Use in Older Adults With Systemic Lupus Erythematosus

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