Tramadol use increases hip fracture risk
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The analgesic medication tramadol was associated with a higher risk for hip fracture compared with codeine and commonly used NSAIDs, according to findings from a population-based study.
“A recently published population-based cohort study reported a significantly higher all-cause mortality rate with tramadol use than with commonly used NSAIDs among patients with osteoarthritis; however, the specific mechanisms linking tramadol use to an increased risk of mortality remains unclear,” Yuqing Zhang, DSc, professor in residence of medicine at Massachusetts General Hospital and Harvard Medical School, and colleagues wrote in the study background. “To date, several studies have reported that tramadol use might increase the risk of falls (a strong risk factor for fracture), but only a few studies have addressed the potential relationship between tramadol use and the risk of fracture, and the results are inconclusive. Furthermore, few, if any, studies have compared the risk of hip fracture, one that ranks among the top 10 leading causes of disability globally, among tramadol initiators with that among initiators of other commonly used analgesics.”
Zhang and colleagues analyzed data from adults aged at least 50 years without a history of hip fracture, cancer or opioid use disorder between 2000 and 2017 in The Health Improvement Network (THIN), a database of medical records from 770 general practices in the United Kingdom. Researchers assessed five sequential propensity score-matched cohorts (mean age, 65.7 years; 56.9% women), including participants who initiated tramadol (n = 146,596) or initiated codeine (n = 146,956), naproxen (n = 115,109), ibuprofen (n = 107,438), celecoxib (n = 43,130) or etoricoxib (n = 27,689). Primary outcome was incident hip fracture during 1 year.
During 1-year of follow-up, researchers observed 518 hip fractures among adults in the tramadol cohort, for a rate of 3.7 per 1,000 person-years, and 401 hip fractures among adults in the codeine cohort, for a rate of 2.9 per 1,000 person-years.
Compared with codeine, the HR for hip fracture among adults prescribed tramadol was 1.28 (95% CI, 1.13-1.46). Risk for hip fracture was also higher for those prescribed tramadol vs. adults prescribed naproxen (HR = 1.69; 95% CI, 1.41-2.03), ibuprofen (HR = 1.65; 95% CI, 1.39-1.96), celecoxib (HR = 1.85; 95% CI, 1.4-2.44) or etoricoxib (HR = 1.96; 95% CI, 1.34 to 2.87).
The researchers noted that the findings suggest there is a need to revisit guidelines on tramadol use in clinical practice.
“Considering the significant impact of hip fracture on morbidity, mortality and health care cost, our results point to the need to consider tramadol’s associated risk of fracture in clinical practice and treatment guidelines,” the researchers wrote. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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