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.
AdvertisementThe 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".