Greater number of narcotic analgesic prescriptions for osteoarthritis is associated with falls and fractures in elderly adults
- PMID: 23452054
- PMCID: PMC3719174
- DOI: 10.1111/jgs.12148
Greater number of narcotic analgesic prescriptions for osteoarthritis is associated with falls and fractures in elderly adults
Abstract
Objectives: To evaluate the changes in types of medications prescribed for pain before and after withdrawal of certain selective cyclooxygenase 2 (COX-2) inhibitors in 2004 and to determine whether there was an association with fall events in elderly adults with a diagnosis of osteoarthritis (OA).
Design: A nested case-control design using electronic medical records compiled between 2001 and 2009.
Setting: Electronic medical records for care provided in an integrated health system in rural Pennsylvania over a 9-year period (2001-09), the midpoint of which rofecoxib and valdecoxib were pulled from the market.
Participants: Thirteen thousand three hundred fifty-four individuals aged 65 to 89 with a diagnosis of OA.
Measurements: The incidence of falls and fractures was examined in relation to analgesics prescribed: narcotics, COX-2 inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs). The comparison sample of individuals who did not fall was matched 3:1 with those who fell according to age, sex, and comorbidity.
Results: Narcotic analgesic prescriptions were associated with a significantly greater risk of falls and fractures. The likelihood of experiencing a fall/fracture was higher in participants prescribed narcotic analgesics than those prescribed a COX-2 inhibitor (odds ratio (OR) = 3.3, 95% confidence interval (CI) = 2.5-4.3) or NSAID (OR = 4.1, 95% CI = 3.7-4.5).
Conclusion: Use of narcotic analgesics is associated with risk of falls and fractures in elderly adults with OA, an observation that suggests that the current guidelines for the treatment of pain, which include first-line prescription of narcotics, should be reevaluated.
© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
Conflict of interest statement
Dr. Cronstein would like to disclose the following, none of which are relevant to this work: Intellectual property: patents on use of adenosine A2A receptor antagonists to promote wound healing and use of A2A receptor antagonists to inhibit fibrosis. Patent on use of adenosine A1 receptor antagonists to treat osteoporosis and other diseases of bone. Patent on use of adenosine A1 and A2B Receptor antagonists to treat fatty liver. Patent on the use of adenosine A2A receptor agonists to prevent prosthesis loosening.
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Comment in
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Use of narcotic analgesics associated with increased falls and fractures in elderly patients with osteoarthritis.Evid Based Med. 2014 Feb;19(1):37-8. doi: 10.1136/eb-2013-101401. Epub 2013 Aug 13. Evid Based Med. 2014. PMID: 23942986 No abstract available.
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[Falls/fractures dependent on pain management].Orthopade. 2015 Apr;44(4):315. Orthopade. 2015. PMID: 26042234 German. No abstract available.
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