Epidemiological study found aged on over 50 mg morphine equivalents had double the fracture rates. Question is why…
J Gen Intern Med. 2010 Apr;25(4):310-5.
Relationship of opioid use and dosage levels to fractures in older chronic pain patients.
Saunders KW, Dunn KM, Merrill JO, Sullivan M, Weisner C, Braden JB, Psaty BM, Von Korff M.
abstract here
- older who received 3+ opioid prescriptions within a 90-day period for chronic, non-cancer pain
- falls were not pretty with 34% being hip or pelvis
What confuses the issue is a study on older farmers:
American Journal of Industrial Medicine
Volume 49 Issue 5, Pages 374 – 382
Pain, medication, and injury in older farmers
D.C. Voaklander, PhD 1 *, K.D. Kelly, BScN, PhD 2, B.H. Rowe, MD, MSc, CCFP(EM) 3, D.P. Schopflocher, PhD 4, L. Svenson, BA 4, N. Yiannakoulias, MA 5, W. Pickett, PhD abstract here
They found that injury was more likely:
“Controlling for co-morbidity, farmers who had stopped taking narcotic pain killers (OR = 9.37 [95% CI:4.95, 17.72]) and non-steroidal anti-inflammatories (OR = 2.40 [95% CI:1.43, 4.03]) 30 days prior to the date of injury were at risk of injury. ”
So was it the opioids or days the subject decided one could do without one’s opioids that caused the problem – that is the problem with epidemiological studies…
Fall risk assessment might help:
here is one from John Hopkins:
any comments?