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Fracture risk associated with the use of morphine and opiates.
J Intern Med 2006; 260(1):76-87JI

Abstract

OBJECTIVES

To study the effect of morphine and opiates on fracture risk.

DESIGN

Case-control study.

SETTING

Nationwide register-based study.

SUBJECTS

Cases were all subjects with any fracture sustained during the year 2000 (n = 124,655). For each case, three controls (n = 373,962) matched on age and gender were randomly drawn from the background population. The primary exposure variables were use of morphine and opiates. Morphine and other opiates had been used by 10 015 (8.0%) of the case subjects and 12 108 (3.2%) of the controls. Adjustments were made for several confounders including prior fracture, and use of weak analgesics [nonsteroidal anti-inflammatory drugs, acetylsalicylic acid (ASA) and acetaminophene]. The effect of dose was examined by stratifying for cumulated dose (defined daily dose).

MAIN OUTCOME MEASURE

Fracture.

RESULTS

Morphine (1.47, 95% CI 1.37-1.58), fentanyl (2.23, 95% CI 1.89-2.64), methadone (1.39, 95% CI 1.05-1.83), oxycodone (1.36, 95% CI 1.08-1.69), nicomorphine (1.57, 95% CI 1.38-1.78), ketobemidone (1.07, 95% CI 1.02-1.13), tramadol (1.54, 95% CI 1.49-1.58) and codeine (1.16, 95% CI 1.12-1.20) were all associated with an increase in overall fracture risk. No increase was present for buprenorphine (0.86, 95% CI 0.79-0.95), pethidine (0.98, 95% CI 0.89-1.08), dextropropoxiphene (1.02, 95% CI 0.90-1.16), and combinations of ASA and codeine (0.94, 95% CI 0.88-1.01).

CONCLUSIONS

An increased fracture risk is seen in users of morphine and opiates. The reason for this may be related to the risk of falls due to central nervous system effects such as dizziness.

Authors+Show Affiliations

Department of Endocrinology and Metabolism, Aarhus Sygehus, Aarhus University Hospital, Aarhus, Denmark. p-vest@post4.tele.dkNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16789982

Citation

Vestergaard, P, et al. "Fracture Risk Associated With the Use of Morphine and Opiates." Journal of Internal Medicine, vol. 260, no. 1, 2006, pp. 76-87.
Vestergaard P, Rejnmark L, Mosekilde L. Fracture risk associated with the use of morphine and opiates. J Intern Med. 2006;260(1):76-87.
Vestergaard, P., Rejnmark, L., & Mosekilde, L. (2006). Fracture risk associated with the use of morphine and opiates. Journal of Internal Medicine, 260(1), pp. 76-87.
Vestergaard P, Rejnmark L, Mosekilde L. Fracture Risk Associated With the Use of Morphine and Opiates. J Intern Med. 2006;260(1):76-87. PubMed PMID: 16789982.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fracture risk associated with the use of morphine and opiates. AU - Vestergaard,P, AU - Rejnmark,L, AU - Mosekilde,L, PY - 2006/6/23/pubmed PY - 2006/8/1/medline PY - 2006/6/23/entrez SP - 76 EP - 87 JF - Journal of internal medicine JO - J. Intern. Med. VL - 260 IS - 1 N2 - OBJECTIVES: To study the effect of morphine and opiates on fracture risk. DESIGN: Case-control study. SETTING: Nationwide register-based study. SUBJECTS: Cases were all subjects with any fracture sustained during the year 2000 (n = 124,655). For each case, three controls (n = 373,962) matched on age and gender were randomly drawn from the background population. The primary exposure variables were use of morphine and opiates. Morphine and other opiates had been used by 10 015 (8.0%) of the case subjects and 12 108 (3.2%) of the controls. Adjustments were made for several confounders including prior fracture, and use of weak analgesics [nonsteroidal anti-inflammatory drugs, acetylsalicylic acid (ASA) and acetaminophene]. The effect of dose was examined by stratifying for cumulated dose (defined daily dose). MAIN OUTCOME MEASURE: Fracture. RESULTS: Morphine (1.47, 95% CI 1.37-1.58), fentanyl (2.23, 95% CI 1.89-2.64), methadone (1.39, 95% CI 1.05-1.83), oxycodone (1.36, 95% CI 1.08-1.69), nicomorphine (1.57, 95% CI 1.38-1.78), ketobemidone (1.07, 95% CI 1.02-1.13), tramadol (1.54, 95% CI 1.49-1.58) and codeine (1.16, 95% CI 1.12-1.20) were all associated with an increase in overall fracture risk. No increase was present for buprenorphine (0.86, 95% CI 0.79-0.95), pethidine (0.98, 95% CI 0.89-1.08), dextropropoxiphene (1.02, 95% CI 0.90-1.16), and combinations of ASA and codeine (0.94, 95% CI 0.88-1.01). CONCLUSIONS: An increased fracture risk is seen in users of morphine and opiates. The reason for this may be related to the risk of falls due to central nervous system effects such as dizziness. SN - 0954-6820 UR - https://www.unboundmedicine.com/medline/citation/16789982/Fracture_risk_associated_with_the_use_of_morphine_and_opiates_ L2 - https://doi.org/10.1111/j.1365-2796.2006.01667.x DB - PRIME DP - Unbound Medicine ER -