Association of Tramadol Use With Risk of Hip Fracture.
|アブストラクト||Several professional organizations have recommended tramadol as one of the first-line or second-line therapies for patients with chronic noncancer pain and its prescription has been increasing rapidly worldwide; however, the safety profile of tramadol, such as risk of fracture, remains unclear. This study aimed to examine the association of tramadol with risk of hip fracture. Among individuals age 50 years or older without a history of hip fracture, cancer, or opioid use disorder in The Health Improvement Network (THIN) database in the United Kingdom general practice (2000-2017), five sequential propensity score-matched cohort studies were assembled, ie, participants who initiated tramadol or those who initiated one of the following medications: codeine (n = 146,956) (another commonly used weak opioid), naproxen (n = 115,109) or ibuprofen (n = 107,438) (commonly used nonselective nonsteroidal anti-inflammatory drugs [NSAIDs]), celecoxib (n = 43,130), or etoricoxib (n = 27,689) (cyclooxygenase-2 inhibitors). The outcome was incident hip fracture over 1 year. After propensity-score matching, the included participants had a mean age of 65.7 years and 56.9% were women. During the 1-year follow-up, 518 hip fracture (3.7/1000 person-years) occurred in the tramadol cohort and 401 (2.9/1000 person-years) occurred in the codeine cohort. Compared with codeine, hazard ratio (HR) of hip fracture for tramadol was 1.28 (95% confidence interval [CI] 1.13 to 1.46). Risk of hip fracture was also higher in the tramadol cohort than in the naproxen (2.9/1000 person-years for tramadol, 1.7/1000 person-years for naproxen; HR = 1.69, 95% CI 1.41 to 2.03), ibuprofen (3.4/1000 person-years for tramadol, 2.0/1000 person-years for ibuprofen; HR = 1.65, 95% CI 1.39 to 1.96), celecoxib (3.4/1000 person-years for tramadol, 1.8/1000 person-years for celecoxib; HR = 1.85, 95% CI 1.40 to 2.44), or etoricoxib (2.9/1000 person-years for tramadol, 1.5/1000 person-years for etoricoxib; HR = 1.96, 95% CI 1.34 to 2.87) cohort. In this population-based cohort study, the initiation of tramadol was associated with a higher risk of hip fracture than initiation of codeine and commonly used NSAIDs, suggesting a need to revisit several guidelines on tramadol use in clinical practice. (c) 2020 American Society for Bone and Mineral Research.|
|ジャーナル名||Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research|
|投稿者||Wei, Jie; Lane, Nancy E; Bolster, Marcy B; Dubreuil, Maureen; Zeng, Chao; Misra, Devyani; Lu, Na; Choi, Hyon K; Lei, Guanghua; Zhang, Yuqing|
|組織名||Health Management Center, Xiangya Hospital, Central South University, Changsha,;China.;Division of Rheumatology, Allergy, and Immunology, Department of Medicine,;Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.;The Mongan Institute, Massachusetts General Hospital, Harvard Medical School,;Boston, MA, USA.;Center for Musculoskeletal Health and Department of Medicine, University of;California School of Medicine, Sacramento, CA, USA.;Boston University School of Medicine, Boston, MA, USA.;VA Boston Healthcare System, Boston, MA, USA.;Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha,;Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical;School, Boston, MA, USA.;Arthritis Research Canada, Richmond, BC, Canada.;National Clinical Research Center of Geriatric Disorders, Xiangya Hospital,;Central South University, Changsha, China.|