Older
people who are placed on short acting opioid analgesic for the treatment of
arthritic pain are more likely to experience a fracture in the coming year as
compared to those on non-steroidal anti inflammatory drugs, according to a
large cohort study.
Dr. Matthew Miller, Associate Director of the
Harvard Injury Control Research Center, Boston and his colleagues conducted a
study on 12,436 arthritis patients who were on opoids and 4,874 initiators who
received NSAIDs. All the participants had arthritis and were 65 and older with
85% of them being females.
The study end point was the one year incidence of
fractures of the hip, ulna, radius, or wrist.
There were 587 fractures reported among the participants who were on
opioids (120 fractures per 1,000 person in a years) and 38 fracture events in
participants initiating NSAIDs (25 fractures per 1,000 person in a years)
The increased risk of fracture was particularly
high during the first two weeks after the initiation of therapy, when the
relative risk was much steeper in patients on opioid than those who were put on
an NSAID or long-acting opioid. Dr. Matthew Miller reported at a conference of
the American Public Health Association that “After the initial 2 week span, the
fracture risk associated with opioid therapy dropped off but remained about
threefold higher than with NSAID therapy”.
The results of the study seems to have the potential
in modifying prescriptions of the clinical practice towards the direction of
greater use of long-acting opioids rather
than the present trend of prescribing short-acting opioids in elderly.
Dr. Miller continued by emphasizing,
“It’s important to understand that the
modern formulations of long-acting drugs can provide adequate analgesia in a
time scale that’s similar to that for short-acting drugs. This is because of
the long-acting agents’ biphasic distribution in the bloodstream. Today, 90% of
the drugs that are being prescribed in an elderly population for arthritis pain
are short-acting drugs. This raises the question of why we’re putting people at
unnecessary risk”.
Reference Article
http://www.medscape.com/viewarticle/739201Source-Medindia