Department of Pain Medicine, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany.
Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Germany.
Eur J Pain. 2018 Oct;22(9):1651-1661. doi: 10.1002/ejp.1247. Epub 2018 Jun 4.
Recent studies revealed an increased prescription rate of opioids for elderly patients suffering bone fractures. To gain further insight, we conducted face-to-face interviews in the present study to compare the opioid intake between patients with low-energy fractures and patients suffering from internal diseases.
In this case-control study, 992 patients, aged 60 years and older, were enrolled between March 2014 and February 2015. The interview comprised a fall and medication history, comorbidities, mobility and other risk factors for fractures. Odds ratios (OR) and a multiple logistic regression model were calculated.
The number of patients with pre-admission opioid intake in the last 12 months was comparable in the fracture (n = 399, 13.3%) and the control group (n = 593, 14.7% OR: 0.89, CI: 0.62-1.29). The number of patients with current opioid intake of short duration (<3 months) was similar in both groups (14% vs. 20%; OR: 0.66, CI: 0.23-1.93). Patients with opioid intake in the fracture group reported more frequently fatigue as an adverse event of opioid medication (58% vs. 30%; OR: 3.32, CI: 1.48-7.45). Patients with opioid intake showed more severe comorbidities and significantly decreased mobility compared to those without opioids.
Elderly patients internalized due to low-energy fractures did not take opioids more frequently than patients with internal admission, for both short (<3 months) and longer duration intake. Patients with opioid intake were generally in poorer physical condition. The risk of fracture might increase in patients suffering from fatigue as a side effect of opioid medication.
This study is based on face-to-face interviews with patients, including details about side effects and fracture history, providing a more pronounced picture of the relation of opioid intake and risk of fracture.
最近的研究表明，骨折的老年患者的阿片类药物处方率有所增加。为了进一步深入了解这一现象，我们在本研究中进行了面对面的访谈，比较了低能量骨折患者和患有内科疾病的患者的阿片类药物摄入量。
在这项病例对照研究中，我们招募了 992 名年龄在 60 岁及以上的患者，他们在 2014 年 3 月至 2015 年 2 月之间接受了访谈，内容包括跌倒和用药史、合并症、活动能力和其他骨折风险因素。计算了比值比（OR）和多因素逻辑回归模型。
在过去 12 个月内有术前阿片类药物摄入的患者数量在骨折组（n=399，13.3%）和对照组（n=593，14.7%；OR：0.89，CI：0.62-1.29）中相似。两组中当前短期（<3 个月）阿片类药物摄入的患者数量相似（14%对 20%；OR：0.66，CI：0.23-1.93）。骨折组服用阿片类药物的患者报告疲劳等不良反应的频率更高（58%对 30%；OR：3.32，CI：1.48-7.45）。与未服用阿片类药物的患者相比，服用阿片类药物的患者合并症更严重，活动能力明显下降。
因低能量骨折而住院的老年患者服用阿片类药物的频率并不高于因内科疾病住院的患者，无论是短期（<3 个月）还是长期服用。服用阿片类药物的患者一般身体状况较差。因服用阿片类药物产生的疲劳等副作用可能会增加骨折的风险。
本研究基于对患者的面对面访谈，包括有关副作用和骨折史的详细信息，为阿片类药物摄入与骨折风险的关系提供了更清晰的认识。
