By Jancin, Bruce
Clinical Psychiatry News , Vol. 39, No. 1
DENVER - Elderly patients who are placed on a short-acting opioid analgesic for treatment of arthritis pain are twice as likely to experience a fracture during the subsequent year, compared with those on a long-acting opioid, according to a large cohort study.
The increased fracture risk was particularly strong during the first 2 weeks after initiation of therapy, when the relative risk was almost sevenfold higher in patients on a short-acting opioid, such as propoxyphene or oxycodone, than in those who were started on a nonsteroidal anti-inflammatory drug (NSAID) or long-acting opioid, including fentanyl or sustained-release hydrocodone. After that initial 2-week period, the fracture risk associated with short-acting opioid therapy dropped off but remained about threefold greater than with NSAID therapy, Dr. Matthew Miller reported.
The fracture risk in the first 2 weeks on a long-acting opioid didn't differ significantly from that in patients placed on an NSAID. Over the course of 1 year, however, the difference grew such that the cumulative fracture risk was 2.6-fold greater in the group on a long-acting opioid than in those on an NSAID. In contrast, the relative risk of fracture at 1 year increased 5.1-fold in elderly arthritis patients on a short-acting opioid, added Dr. Miller, associate director of the Harvard Injury Control Research Center, Boston.
"Our findings indicate that opioids increase the risk of fractures among older patients with arthritis, and suggest that clinicians should be alert to the possibility that short-acting opioids pose a significantly greater risk of fractures among older adults than do equianalgesic doses of long-acting opioids, especially during the first 2 weeks" of therapy, he said.
These results have the potential to change clinical practice by shifting prescribing in the direction of greater use of long-acting opioids in the elderly. …