Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, Aarhus, Denmark.
Osteoporos Int. 2012 Apr;23(4):1255-65. doi: 10.1007/s00198-011-1692-0. Epub 2011 Jun 28.
Pain medication has been associated with fractures. We found higher weight in paracetamol and non-steroidal anti-inflammatory drugs (NSAID) users and lower vitamin D levels in opioid and acetylsalicylic acid users. None of the pain medications influenced bone mineral density or loss. NSAID were associated with an increased fracture risk.
To study the effects of use of paracetamol, non-steroidal anti-inflammatory drugs (NSAID), acetylsalicylic acid (ASA), and opioids on bone mineral density (BMD) and risk of fractures.
Two-thousand sixteen perimenopausal women followed for 10 years as part of a partly randomised comprehensive cohort study on hormone therapy (HT). BMD was measured at baseline and after 10 years by DXA (Hologic).
Paracetamol users were heavier (70.4 ± 13.4 vs. 67.7 ± 11.9 kg, 2p < 0.01) than non-users. NSAID users were heavier (71.6 ± 15.6 vs. 67.8 ± 11.9 kg, 2p = 0.04) than non-users. ASA users had lower 25-hydroxy-vitamin D (25OHD) levels (21.9 ± 9.3 vs. 25.3 ± 12.4 ng/ml, 2p < 0.01) than non-users. Opioid users had lower 25OHD (21.4 ± 8.4 vs. 25.2 ± 12.3 ng/ml) and lower intake of vitamin D (2.2 ± 1.1 vs. 3.1 ± 3.0 μg/day, 2p < 0.01) than non-users. Despite these differences, no baseline differences were present in spine, hip, forearm or whole body BMD. Over 10 years, no differences were present in BMD alterations except a small trend towards a higher BMD gain in the spine in users of paracetamol, NSAID, ASA, and opioids compared to non-exposed. After adjustment, NSAID exposed sustained more fractures (HR = 1.44, 95% CI 1.07-1.93) than non-users. For users of paracetamol and opioids, a non-significant trend towards more fractures was present after adjustment. For ASA users, no excess risk of fractures was present.
Significant differences exist between subjects exposed to pain medications and non-users. Despite an absence of an effect over time on BMD, users of NSAID experienced more fractures than expected. The reasons for this have to be explored in further studies.
止痛药与骨折有关。我们发现，扑热息痛和非甾体抗炎药（NSAID）使用者体重较高，而阿片类药物和乙酰水杨酸使用者的维生素 D 水平较低。没有一种止痛药会影响骨密度或流失。NSAID 与骨折风险增加有关。
研究使用扑热息痛、非甾体抗炎药（NSAID）、乙酰水杨酸（ASA）和阿片类药物对骨密度（BMD）和骨折风险的影响。
2016 年，1600 名绝经前妇女作为激素治疗（HT）部分随机综合队列研究的一部分进行了 10 年的随访。基线和 10 年后通过 DXA（Hologic）测量 BMD。
扑热息痛使用者体重较重（70.4±13.4 与 67.7±11.9kg，2p<0.01）。NSAID 使用者体重较重（71.6±15.6 与 67.8±11.9kg，2p=0.04）。ASA 使用者 25-羟维生素 D（25OHD）水平较低（21.9±9.3 与 25.3±12.4ng/ml，2p<0.01）。阿片类药物使用者 25OHD 水平较低（21.4±8.4 与 25.2±12.3ng/ml）和维生素 D 摄入量较低（2.2±1.1 与 3.1±3.0μg/天，2p<0.01）。尽管存在这些差异，但在脊柱、臀部、前臂或全身 BMD 方面没有基线差异。10 年内，除了扑热息痛、NSAID、ASA 和阿片类药物使用者的脊柱 BMD 有轻微增加趋势外，BMD 变化无差异。调整后，与未暴露者相比，NSAID 暴露者骨折持续时间更长（HR=1.44，95%CI1.07-1.93）。扑热息痛和阿片类药物使用者调整后骨折风险呈上升趋势，但无统计学意义。ASA 使用者骨折风险无增加。
暴露于止痛药的受试者与未使用者之间存在显著差异。尽管随着时间的推移对 BMD 没有影响，但 NSAID 使用者的骨折发生率高于预期。这一现象的原因需要在进一步的研究中探讨。
