The impact of opioid medications on subsequent fractures in discharged emergency department patients with peripheral vertigo

Grewal, Keerat; Austin, Peter C.; Kapral, Moira K.; Lu, Hong; Atzema, Clare

doi:10.1017/cem.2017.37

Cited by 4 publications

(13 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

“…The detailed process of inclusion in this study is shown in Fig 1. Five studies were from the United States [12,21,23,24,26,32], three from Canada [9,19,28], two from the United Kingdom [18,27], one study was from Australia, and the remaining came from European countries; 12 articles were from cohort studies, and six were from case-control studies. The study information is shown in Table 1.…”

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%

“…The results showed that the use of opioids increased the risk of fracture. Previously, the most recent meta-analysis (Ping et al [33]) was limited to the study of hip fractures, and Grewal et al [9] showed that patients taking opioids had a risk of fracture after discharge compared with patients who were not taking opioids. The main reason for the increase was that patients taking opioids were prone to vertigo and falls that can lead to fractures.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, although our overall analysis showed heterogeneity, we determined the source of the heterogeneity through subgroup analyses. For example, Shorr, Grewal, Miller, and Laura were all retrospective studies [9,19,24,26]. In the subgroup analysis, heterogeneity was significantly reduced suggesting that these retrospective cohort studies may have been a source of heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

See 4 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

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.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 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

Patterns of prescription opioid use in Swiss emergency department patients and its association with outcome: a retrospective analysis

et al. 2020

View full text Add to dashboard Cite

ObjectivesWe aimed to clarify the prevalence, indications, analgesic comedications and complications of prescription opioid use in patients presenting to a large emergency department (ED).DesignRetrospective chart review.SettingLarge, interdisciplinary ED of a public hospital.ParticipantsAll patients aged ≥18 years presenting between 1 January 2017, and 31 December 2018, with documentation on medication were included.InterventionsNone.Primary and secondary outcome measuresPrevalence rates for prescription opioid use and its indication. Prevalence of analgesic comedications in prescription opioid users. Hospitalisation rate, 72 hours ED reconsultation rate, 30-day rehospitalisation rate, in-hospital mortality.ResultsA total of 26 224 consultations were included in the analysis; 1906 (7.3%) patients had prescriptions for opioids on admission to the ED. The main indications for opioid prescriptions were musculoskeletal disease in 1145 (60.1%) patients, followed by neoplastic disease in 374 (19.6%) patients. One hundred fifty-four (8.2%) consultations were directly related to opioid intake, and 50.1% of patients on opioids also used other classes of analgesics. Patients on prescription opioids were older (76 vs 62 years, p<0.0001) and female individuals were over-represented (58 vs 48.9%, p<0.0001). Hospitalisation rate (78.3 vs 49%, p<0.0001), 72 hours ED reconsultation rate (0.8 vs 0.3%, p=0.004), 30-day rehospitalisation rate (6.2 vs 1.5%, p<0.0001) and in-hospital mortality (6.3 vs 1.6%, p<0.0001) were significantly higher in patients with opioid therapy than other patients. In 25 cases (1.3%), admission to the ED was due to opioid intoxication.ConclusionsDaily prescription opioid use is common in patients presenting to the ED. The use of prescription opioids is associated with adverse outcomes, whereas intoxication is a minor issue in the studied population.

show abstract

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.

show abstract

The impact of opioid medications on subsequent fractures in discharged emergency department patients with peripheral vertigo

Cited by 4 publications

References 17 publications

An updated analysis of opioids increasing the risk of fractures

An updated analysis of opioids increasing the risk of fractures

Patterns of prescription opioid use in Swiss emergency department patients and its association with outcome: a retrospective analysis

An updated analysis of opioids increasing the risk of fractures

Contact Info

Product

Resources

About