Opioid Use and Risk of Nonvertebral Fractures in Adults With Rheumatoid Arthritis: A Nested Case–Control Study Using Administrative Databases

Acúrcio, Francisco de Assis; Moura, Cristiano Soares de; Bernatsky, Sasha; Bessette, Louis; Rahme, Elham

doi:10.1002/art.39422

Cited by 33 publications

(25 citation statements)

References 46 publications

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“…Claims‐based studies indicate that the prevalence of opioid prescriptions for individuals with RA increased substantially in the late 1990s and early 2000s, with rates stabilizing in the mid‐2000s to mid‐2010s . While there is weak evidence that opioids are efficacious for the treatment of pain in RA , there is growing evidence that opioids are associated with serious risks, including nonvertebral fractures and serious infections . These observations highlight the importance of understanding the prevalence and predictors of chronic opioid use in RA.…”

Section: Introductionmentioning

confidence: 99%

Chronic Opioid Use in Rheumatoid Arthritis: Prevalence and Predictors

Lee

Kremer

Guan

et al. 2019

Arthritis & Rheumatology

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Objective. The opioid epidemic is a major public health concern. However, little is known about opioid use among rheumatoid arthritis (RA) patients. We undertook this study to examine trends in chronic opioid use in RA patients in 2002-2015 and to identify clinical predictors.Methods. RA patients were identified from the Corrona registry. Opioid use was ascertained from surveys obtained at clinical visits as often as every 3 months. Chronic opioid use was defined as any opioid use reported during ≥2 consecutive study visits. Annual prevalence of chronic opioid use was calculated using data from 33,739 RA patients with information on opioid use from ≥2 visits. Among the 26,288 individuals who were not taking opioids at baseline, Cox proportional hazards models identified associations between patient characteristics and incident chronic opioid use. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated.Results. Chronic opioid use increased from 7.4% in 2002 to 16.9% in 2015. Severe pain (HR 2.53 [95% CI 2.19-2.92]) and antidepressant use (HR 1.79 [95% CI 1.64-1.92]) were associated with an increased risk of chronic opioid use. High disease activity (HR 1.55 [95% CI 1.30-1.84]) and a high level of disability (HR 1.45 [95% CI 1.27-1.65]) were also associated with chronic opioid use, whereas Asian ethnicity (HR 0.49 [95% CI 0.36-0.68]) was associated with a decreased risk of chronic opioid use.Conclusion. Among RA patients, chronic opioid use doubled from 2002 to 2015. Pain and antidepressant use were the strongest predictors of chronic opioid use. To curb the rise in chronic opioid use, strategies for stringent control of RA disease activity and management of pain and depression should be research priorities.

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Section: Introductionmentioning

confidence: 99%

Chronic Opioid Use in Rheumatoid Arthritis: Prevalence and Predictors

Lee

Kremer

Guan

et al. 2019

Arthritis & Rheumatology

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“…The detailed process of inclusion in this study is shown in Fig 1. Five studies were from the United States [12,21,23,24,26,32], three from Canada [9,19,28], two from the United Kingdom [18,27], one study was from Australia, and the remaining came from European countries; 12 articles were from cohort studies, and six were from case-control studies. The study information is shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, there are two main mechanisms for the occurrence of fractures with opioid use. One mechanism is that opioids may reduce bone density by inhibiting the production of endogenous sex hormones, leading to an increased risk of fractures [34]; the other mechanism involves the side effects of opioids, such as the central nervous system side effects of vertigo, fatigue, etc., that lead to the occurrence of fractures [7,9,27,28], and there is a high incidence of side effects, including acute cognitive deterioration, increased sputum production, decreased oxygen saturation, and constipation, after the use of opioids in elderly populations, as confirmed in recent studies [35]. The trend of the population aging is becoming increasingly pronounced, and osteoporosis in this aging population is a serious concern.…”

Section: Discussionmentioning

confidence: 99%

An updated analysis of opioids increasing the risk of fractures

Yue

Teng

et al. 2019

Preprint

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AbstractObjectiveTo assess the relationship between opioid therapy for chronic noncancer pain and fracture risk by a meta-analysis of cohort studies and case-control studies.MethodsThe included cohort studies and case-control studies were identified by searching the PubMed and EMBASE databases from their inception until May 24, 2019. The outcome of interest was a fracture. This information was independently screened by two authors. When the heterogeneity among studies was significant, a random effects model was used to determine the overall combined risk estimate.ResultsIn total, 12 cohort studies and 6 case-control studies were included. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of the included literature, and 14 of the studies were considered high-quality studies. The overall relative risk of opioid therapy and fractures was 1.78 (95% confidence interval (CI) 1.53 - 2.07). Subgroup analyses revealed sources of heterogeneity, sensitivity analysis was stable, and no publication bias was observed.ConclusionsThe meta-analysis showed that the use of opioids significantly increased the risk of fracture.

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“…Using predefined search strategies and inclusion criteria, a total of 18 studies were included and 1,134 articles of unrelated literature were excluded (from a total of 600 articles from PubMed and 552 articles from EMBASE) after a detailed reading of the title, abstract, and full text, and the 18 articles included 884054 participants [3,7,9,[19][20][21][22][23][24][25][26][27][28][29][30][31][32]. The detailed process of inclusion in this study is shown in Fig 1. Five studies were from the United States [12,21,23,24,26,32], three from Canada [9,19,28], two from the United Kingdom [18,27], one study was from Australia, and the remaining came from European countries; 12 articles were from cohort studies, and six were from case-control studies. The study information is shown in Table 1.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

An updated analysis of opioids increasing the risk of fractures

Yue

Teng

et al. 2020

PLoS ONE

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Objective To assess the relationship between opioid therapy for chronic noncancer pain and fracture risk by a meta-analysis of cohort studies and case-control studies. Methods The included cohort studies and case-control studies were identified by searching the PubMed and EMBASE databases from their inception until May 24, 2019. The outcome of interest was a fracture. This information was independently screened by two authors. When the heterogeneity among studies was significant, a random effects model was used to determine the overall combined risk estimate. Results In total, 12 cohort studies and 6 case-control studies were included. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of the included literature, and 14 of the studies were considered high-quality studies. The overall relative risk of opioid therapy and fractures was 1.78 (95% confidence interval (CI) 1.53-2.07). Subgroup analyses revealed sources of heterogeneity, sensitivity analysis was stable, and no publication bias was observed. Conclusions The meta-analysis showed that the use of opioids significantly increased the risk of fracture.

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Opioid Use and Risk of Nonvertebral Fractures in Adults With Rheumatoid Arthritis: A Nested Case–Control Study Using Administrative Databases

Abstract: Among RA patients, the risk of nonvertebral fracture is increased in those treated with opioids.

Cited by 33 publications

References 46 publications

Chronic Opioid Use in Rheumatoid Arthritis: Prevalence and Predictors

Chronic Opioid Use in Rheumatoid Arthritis: Prevalence and Predictors

An updated analysis of opioids increasing the risk of fractures

An updated analysis of opioids increasing the risk of fractures

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