The association of opioid use with incident lower extremity fractures in spinal cord injury

Abstract

Objective: To determine the association between opioid use and lower extremity fracture risk in men with spinal cord injury (SCI). Design: Retrospective cohort study. approximately 70% of the cohort having received a prescription for an opioid. Overall, there were 892 incident lower extremity fractures over the time period of this study (597 fractures in the opioid users and 295 fractures in the non-opioid users). After adjusting for covariates, there was a statistically significant relationship between opioid use and increased risk for lower extremity fractures (hazard ratio 1.82 (95% confidence interval 1.59-2.09)). Shorter duration of use (<6 months) and higher doses were positively related to fracture risk (P < 0.0001). Conclusions: Opioid use is quite common in SCI and is associated with an increased risk for lower extremity fractures. Careful attention to fracture prevention is warranted in patients with SCI, particularly upon initiation of an opioid prescription and when higher doses are used.

Medication-related problems in individuals with spinal cord injury in a primary care-based clinic

“…Drugs within these classes increase the risk of falls, and even though those with SCI may not be ambulatory, falls and limitations in mobility can still occur. 10,13 In a population of more than 7000 male veterans with a history of traumatic SCI, opioid use was associated with an increase in risk of lower extremity fractures. 13 Furthermore, daily use of medications for pain and spasticity may limit the SCI patient's ability to ambulate or mobilize and cause fatigue.…”

“…10,13 In a population of more than 7000 male veterans with a history of traumatic SCI, opioid use was associated with an increase in risk of lower extremity fractures. 13 Furthermore, daily use of medications for pain and spasticity may limit the SCI patient's ability to ambulate or mobilize and cause fatigue. 11,12 Pharmacist participation in interprofessional teams has been demonstrated to improve health outcomes in patients with other medical conditions.…”

“…6 The chronicity of secondary health conditions, their comorbidity, the limited efficacy of pharmacotherapy along with the increased likelihood of polypharmacy expose patients with SCI to a multitude of drug-related problems. 4,[7][8][9][10][11][12][13] Comprehensive healthcare in Canada starts with a patient's primary care provider, i.e. the family physician is the patient's first point of contact for assessment, diagnosis, and treatment as well the healthcare provider who coordinates care of community-dwelling patients.…”

Opioid receptor agonists may favorably affect bone mechanical properties in rats with estrogen deficiency-induced osteoporosis

“…However, those studies did not determine the changes in the skeletal system, and the data were rather not adjusted for other factors, like the treated diseases and poor general health status. Other studies demonstrated that the use of opioid analgesics is associated with an increased risk of fractures, to which the increased risk of falls may contribute (Ensrud et al 2003; Vestergaard et al 2006; Saunders et al 2010; Miller et al 2011; Carbone et al 2013; Li et al 2013). …”

“…The population-based and clinical studies indicate rather damaging effects of opioids on bone leading to a reduction in bone mineral density (BMD) (Pedrazzoni et al 1993; Kim et al 2006; Fortin et al 2008; Dürsteler-MacFarland et al 2011; Grey et al 2011; Duarte et al 2013) and increased risk of fracture (Guo et al 1998; Ensrud et al 2003; Vestergaard et al 2006; Saunders et al 2010; Solomon et al 2010; Miller et al 2011; Carbone et al 2013; Li et al 2013), although recently two reports indicating possible favorable opioid effects on the skeletal system in women have been published (Vestergaard et al 2012; Lee et al 2013). The unfavorable effects of opioids on the skeletal system are usually attributed to inhibitory effects on the endocrine system (hypogonadism), as well as increased tendency to falls (Vestergaard et al 2006; Daniell 2008; Saunders et al 2010; Brennan 2013; Duarte et al 2013); however, results of a small number of in vitro and in vivo experimental studies suggest that opioids may also act directly on bone tissue and exert differential effects (Hall et al 1996; Pérez-Castrillón et al 2000; King et al 2007; Akhoundi et al 2010; Bastos et al 2011; Boshra 2011; Ezzatabadipour et al 2011; Chrastil et al 2013).…”