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Opioids increase hip fracture risk: a meta-analysis

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Abstract

The relationship between hip fracture risk and opioid use remains controversial. Thus, we performed a meta-analysis to assess the risk of hip fracture among opioid users. PubMed and EMBASE were searched for studies published from the inception of the databases until June 2015. The information was extracted independently by two teams of authors. When the heterogeneity was significant, the random-effects model was used to calculate the overall pooled risk estimates. Ten studies with 697,011 patients were included in the final meta-analysis. The overall combined relative risk for the use of opioids and hip fracture was 1.54 [95 % confidence interval (CI) 1.34–1.77]. Subgroup analyses revealed sources of heterogeneity, and sensitivity analysis indicated stable results, and no publication bias was observed. This meta-analysis demonstrates that opioids significantly increase the risk of hip fracture.

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References

  1. Parker MJ, Pryor GA (1993) Hip fracture management. Blackwell Scientific Publications, Oxford

    Google Scholar 

  2. Cooper C, Campion G, Melton L III (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2:285–289

    Article  CAS  PubMed  Google Scholar 

  3. Shen GS, Li Y, Zhao G et al (2015) Cigarette smoking and risk of hip fracture in women: a meta-analysis of prospective cohort studies. Injury 46:1333–1340

    Article  PubMed  Google Scholar 

  4. Kanungo J, Cuevas E, Guo X et al (2012) Nicotine alters the expression of molecular markers of endocrine disruption in zebrafish. Neurosci Lett 526:133–137

    Article  CAS  PubMed  Google Scholar 

  5. Gumieiro DN, Murino Rafacho BP, Buzati Pereira BL et al (2015) Vitamin D serum levels are associated with handgrip strength but not with muscle mass or length of hospital stay after hip fracture. Nutrition 31:931–934

    Article  CAS  PubMed  Google Scholar 

  6. Teng Z, Zhu Y, Wu F et al (2015) Opioids contribute to fracture risk: a meta-analysis of 8 cohort studies. PLoS One 10:e0128232

    Article  PubMed  PubMed Central  Google Scholar 

  7. Stewart G, Owen M (2013) Opioids in the management of persistent non-cancer pain. Anaesth Intensive Care Med 14:533–535

    Article  Google Scholar 

  8. Takkouche B, Montes-Martínez A, Gill SS et al (2007) Psychotropic medications and the risk of fracture. Drug Saf 30:171–184

    Article  PubMed  Google Scholar 

  9. Thorell K, Ranstad K, Midlöv P et al (2014) Is use of fall risk-increasing drugs in an elderly population associated with an increased risk of hip fracture, after adjustment for multimorbidity level: a cohort study. BMC Geriatr 14:131

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lindestrand AG, Christiansen MLS, Jantzen C et al (2015) Opioids in hip fracture patients: an analysis of mortality and post hospital opioid use. Injury 46:1341–1345

    Article  PubMed  Google Scholar 

  11. Compton WM, Volkow ND (2006) Major increases in opioid analgesic abuse in the United States: concerns and strategies. Drug Alcohol Depend 81:103–107

    Article  PubMed  Google Scholar 

  12. Guo Z, Wills P, Viitanen M et al (1998) Cognitive impairment, drug use, and the risk of hip fracture in persons over 75 years old: a community-based prospective study. Am J Epidemiol 148:887–892

    Article  CAS  PubMed  Google Scholar 

  13. Card T, West J, Hubbard R et al (2004) Hip fractures in patients with inflammatory bowel disease and their relationship to corticosteroid use: a population based cohort study. Gut 53:251–255

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Li L, Setoguchi S, Cabral H et al (2013) Opioid use for noncancer pain and risk of fracture in adults: a nested case–control study using the general practice research database. Am J Epidemiol 178:559–569

    Article  PubMed  Google Scholar 

  15. Leach MJ, Pratt NL, Roughead EE (2015) Psychoactive medicine use and the risk of hip fracture in older people: a case-crossover study. Pharmacoepidemiol Drug Saf 6:576–582

    Article  Google Scholar 

  16. Ensrud KE, Blackwell T, Mangione CM et al (2003) Central nervous system active medications and risk for fractures in older women. Arch Intern Med 163:949–957

    Article  PubMed  Google Scholar 

  17. Jensen J, Nielsen L, Lyhne N et al (1991) Drugs and femoral neck fracture: a case–control study. J Intern Med 229:29–33

    Article  CAS  PubMed  Google Scholar 

  18. Higgins J, Thompson SG, Deeks JJ et al (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  19. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  20. Woolf B (1955) On estimating the relation between blood group and disease. Ann Hum Genet 19:251–253

    Article  CAS  PubMed  Google Scholar 

  21. Egger M, Smith GD, Schneider M et al (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101

    Article  CAS  PubMed  Google Scholar 

  23. Shorr RI, Griffin MR, Daugherty JR et al (1992) Opioid analgesics and the risk of hip fracture in the elderly: codeine and propoxyphene. J Gerontol 47:M111–M115

    Article  CAS  PubMed  Google Scholar 

  24. Vestergaard P, Rejnmark L, Mosekilde L (2006) Fracture risk associated with the use of morphine and opiates. J Intern Med 260:76–87

    Article  CAS  PubMed  Google Scholar 

  25. Kamal-Bahl SJ, Stuart BC, Beers MH (2006) Propoxyphene use and risk for hip fractures in older adults. Am J Geriatr Pharmacother 4:219–226

    Article  CAS  PubMed  Google Scholar 

  26. Wu AM, Huang CQ, Lin ZK et al (2014) The relationship between vitamin A and risk of fracture: meta-analysis of prospective studies. J Bone Miner Res 29:2032–2039

    Article  CAS  PubMed  Google Scholar 

  27. Vuong C, Van Uum SH, O’Dell LE et al (2010) The effects of opioids and opioid analogs on animal and human endocrine systems. Endocr Rev 31:98–132

    Article  CAS  PubMed  Google Scholar 

  28. Vallejo R, de Leon-Casasola O, Benyamin R (2004) Opioid therapy and immunosuppression: a review. Am J Ther 11:354–365

    Article  PubMed  Google Scholar 

  29. Ricardo Buenaventura M, Rajive Adlaka M, Nalini Sehgal M (2008) Opioid complications and side effects. Pain Physician 11:S105–S120

    PubMed  Google Scholar 

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Correspondence to Hua Zhi or Yugang Liu.

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Ping, F., Wang, Y., Wang, J. et al. Opioids increase hip fracture risk: a meta-analysis. J Bone Miner Metab 35, 289–297 (2017). https://doi.org/10.1007/s00774-016-0755-x

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  • DOI: https://doi.org/10.1007/s00774-016-0755-x

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