Greater number of narcotic analgesic prescriptions for osteoarthritis is associated with falls and fractures in elderly adults
L Rolita, A Spegman, X Tang… - Journal of the American …, 2013 - Wiley Online Library
L Rolita, A Spegman, X Tang, BN Cronstein
Journal of the American Geriatrics Society, 2013•Wiley Online LibraryObjectives 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 …
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 …
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.
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