Boston Collaborative Drug Surveillance Program, School of Public Health, Boston University, Lexington, MA, USA.
Am J Epidemiol. 2013 Aug 15;178(4):559-69. doi: 10.1093/aje/kwt013. Epub 2013 May 2.
Opioid use has been reported to be associated with increased fracture risks. In a nested case-control study using the United Kingdom-based General Practice Research Database, we tested the hypotheses that fracture risk was associated with 1) an elevated risk of falls caused by the acute central nervous system effects of opioids including sedation and dizziness, and 2) osteoporosis caused by chronic opioid-induced hypogonadism. Among a cohort of adults aged 18-80 years without cancer who received ≥1 opioid prescription during 1990-2008, we selected cases with a first diagnosed fracture of the hip, humerus, or wrist; up to 4 controls, matched by age, sex, index date (date of the first diagnosed fracture), and general practice, were randomly selected for each case. Adjusted odds ratios and 95% confidence intervals were estimated by using conditional logistic regression. Current use of 1 prescription was associated with a strong risk of fracture (adjusted odds ratio = 2.70, 95% confidence interval: 2.34, 3.13). The risk decreased with increasing use. There was no association with current use of >20 opioid prescriptions. The findings were consistent for all study fractures and for most common opioids, suggesting that acute central nervous system effects of opioids rather than chronic opioid-induced hypogonadism play a key role in fracture risk.
阿片类药物的使用与骨折风险增加有关。在一项使用英国基于普通实践研究数据库的巢式病例对照研究中，我们检验了以下假设：骨折风险与 1）阿片类药物的急性中枢神经系统效应引起的跌倒风险增加有关，包括镇静和头晕，以及 2）慢性阿片类药物诱导的性腺功能减退症引起的骨质疏松症有关。在 1990-2008 年期间接受至少 1 次阿片类药物处方的 18-80 岁成年人队列中，我们选择了首次诊断为髋部、肱骨或腕部骨折的病例；对于每个病例，通过年龄、性别、索引日期（首次诊断骨折日期）和普通实践，随机选择最多 4 名匹配的对照。使用条件逻辑回归估计调整后的优势比和 95%置信区间。目前使用 1 种处方与骨折风险显著增加相关（调整后的优势比=2.70，95%置信区间：2.34，3.13）。风险随使用量的增加而降低。与当前使用 >20 种阿片类药物处方无关。所有研究骨折和大多数常用阿片类药物的结果一致，这表明阿片类药物的急性中枢神经系统效应而非慢性阿片类药物诱导的性腺功能减退症在骨折风险中起关键作用。
