In the Journals

Opioid use linked to increased hip fracture risk for patients on hemodialysis

Findings indicated use of opioid analgesics was associated with increased risk for hip fracture among patients on maintenance hemodialysis.

According to Chandan Vangala, MD, MS, of Baylor College of Medicine in Houston, and colleagues, many patients on hemodialysis experience difficulties with pain.

“From generalizable aches to more specific neuropathies to intermittent vascular claudication, pain is prevalent among patients with kidney disease,” they wrote. “Additionally, the necessity of obtaining vascular access and the abrupt process of [hemodialysis] HD not only generates new discomforts, but likely exacerbates ongoing episodes of pain.”

They noted that, for this patient population, the risk for hip fractures is at least four times that of the general population.

While previous studies have demonstrated an association between opioid use and hip fracture events in the general population, the researchers wrote that this association has not been well-studied for those on hemodialysis.

Using the U.S. Renal Data System, the researchers first identified all hip fracture events experienced by patients on hemodialysis between 2009 and 2015. Each eligible case (4,912 first-time hip fracture cases) was then matched with 10 controls

Both long- and short- term exposure to opioids were considered, with short-term exposure specifically examining exposure in the 6 months before index date.

Opioid use included prescriptions for buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, pentazocine, propoxyphene, tapentadol or tramadol.

Use was further divided into “any/low” (at least one prescription filled in the 3 years before index date), “moderate” or “high” (opioid prescriptions covering > 80% of days in the 3-year period before index date).

Researchers found more than 80% of patients who experienced a hip fracture were exposed to opioids in the 3 years before their fracture.

Long-term opioid use was associated with increased hip fracture risk (adjusted OR [aOR]= 1.39). Patients with low, moderate and high use had 1.33, 1.53 and 1.66 higher odds of hip fracture, respectively.

In addition, an association was observed between new, short-term use and elevated hip fracture risk (aOR = 1.38).

“When formally comparing this exposure to that of risk-set matched controls, and adjusting for a number of established hip fracture risk factors and other potential confounders, we found that cases were 39% more likely to have any opioid exposure than controls,” the researchers wrote. “If opioid use were eliminated entirely, we estimate that hip fracture incidence would be reduced by up to 25%.” – by Melissa J. Webb

Disclosures: Vangala reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Findings indicated use of opioid analgesics was associated with increased risk for hip fracture among patients on maintenance hemodialysis.

According to Chandan Vangala, MD, MS, of Baylor College of Medicine in Houston, and colleagues, many patients on hemodialysis experience difficulties with pain.

“From generalizable aches to more specific neuropathies to intermittent vascular claudication, pain is prevalent among patients with kidney disease,” they wrote. “Additionally, the necessity of obtaining vascular access and the abrupt process of [hemodialysis] HD not only generates new discomforts, but likely exacerbates ongoing episodes of pain.”

They noted that, for this patient population, the risk for hip fractures is at least four times that of the general population.

While previous studies have demonstrated an association between opioid use and hip fracture events in the general population, the researchers wrote that this association has not been well-studied for those on hemodialysis.

Using the U.S. Renal Data System, the researchers first identified all hip fracture events experienced by patients on hemodialysis between 2009 and 2015. Each eligible case (4,912 first-time hip fracture cases) was then matched with 10 controls

Both long- and short- term exposure to opioids were considered, with short-term exposure specifically examining exposure in the 6 months before index date.

Opioid use included prescriptions for buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, pentazocine, propoxyphene, tapentadol or tramadol.

Use was further divided into “any/low” (at least one prescription filled in the 3 years before index date), “moderate” or “high” (opioid prescriptions covering > 80% of days in the 3-year period before index date).

Researchers found more than 80% of patients who experienced a hip fracture were exposed to opioids in the 3 years before their fracture.

Long-term opioid use was associated with increased hip fracture risk (adjusted OR [aOR]= 1.39). Patients with low, moderate and high use had 1.33, 1.53 and 1.66 higher odds of hip fracture, respectively.

In addition, an association was observed between new, short-term use and elevated hip fracture risk (aOR = 1.38).

“When formally comparing this exposure to that of risk-set matched controls, and adjusting for a number of established hip fracture risk factors and other potential confounders, we found that cases were 39% more likely to have any opioid exposure than controls,” the researchers wrote. “If opioid use were eliminated entirely, we estimate that hip fracture incidence would be reduced by up to 25%.” – by Melissa J. Webb

Disclosures: Vangala reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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