Hip Fracture Risk among Hemodialysis-Dependent Patients Prescribed Opioids and Gabapentinoids.
United States Renal Data System
clinical epidemiology
mineral metabolism
Journal
Journal of the American Society of Nephrology : JASN
ISSN: 1533-3450
Titre abrégé: J Am Soc Nephrol
Pays: United States
ID NLM: 9013836
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
11
09
2019
accepted:
11
03
2020
pubmed:
7
5
2020
medline:
5
1
2021
entrez:
7
5
2020
Statut:
ppublish
Résumé
Despite opioids' known association with hip fracture risk in the general population, they are commonly prescribed to patients with ESKD. Whether use of opioids or gabapentinoids (also used to treat pain in patients with ESKD) contributes to hip fracture risk in patients with ESKD on hemodialysis remains unknown. In a case-control study nested within the US Renal Data System, we identified all hip fracture events recorded among patients dependent on hemodialysis from January 2009 through September 2015. Eligible cases were risk-set matched on index date with ten eligible controls. We required >1 year of Medicare Parts A and B coverage and >3 years of part D coverage to study cumulative longer-term exposure. To examine new, short-term exposure, we selected individuals with >18 months of Part D coverage and no prior opioid or gabapentinoid use between 18 and 7 months before index. We used conditional logistic regression to estimate unadjusted and multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (95% CI). For the longer-term analyses, we identified 4912 first-time hip fracture cases and 49,120 controls. Opioid use was associated with increased hip fracture risk (adjusted OR, 1.39; 95% CI, 1.26 to 1.53). Subgroups of low, moderate, and high use yielded adjusted ORs of 1.33 (95% CI, 1.20 to 1.47), 1.53 (95% CI, 1.36 to 1.72), and 1.66 (95% CI, 1.45 to 1.90), respectively. The association with hip fractures was also elevated with new, short-term use (adjusted OR, 1.38; 95% CI, 1.25 to 1.52). There were no associations between gabapentinoid use and hip fracture. Among patients dependent on hemodialysis in the United States, both short-term and longer-term use of opioid analgesics were associated with hip fracture events.
Sections du résumé
BACKGROUND
Despite opioids' known association with hip fracture risk in the general population, they are commonly prescribed to patients with ESKD. Whether use of opioids or gabapentinoids (also used to treat pain in patients with ESKD) contributes to hip fracture risk in patients with ESKD on hemodialysis remains unknown.
METHODS
In a case-control study nested within the US Renal Data System, we identified all hip fracture events recorded among patients dependent on hemodialysis from January 2009 through September 2015. Eligible cases were risk-set matched on index date with ten eligible controls. We required >1 year of Medicare Parts A and B coverage and >3 years of part D coverage to study cumulative longer-term exposure. To examine new, short-term exposure, we selected individuals with >18 months of Part D coverage and no prior opioid or gabapentinoid use between 18 and 7 months before index. We used conditional logistic regression to estimate unadjusted and multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (95% CI).
RESULTS
For the longer-term analyses, we identified 4912 first-time hip fracture cases and 49,120 controls. Opioid use was associated with increased hip fracture risk (adjusted OR, 1.39; 95% CI, 1.26 to 1.53). Subgroups of low, moderate, and high use yielded adjusted ORs of 1.33 (95% CI, 1.20 to 1.47), 1.53 (95% CI, 1.36 to 1.72), and 1.66 (95% CI, 1.45 to 1.90), respectively. The association with hip fractures was also elevated with new, short-term use (adjusted OR, 1.38; 95% CI, 1.25 to 1.52). There were no associations between gabapentinoid use and hip fracture.
CONCLUSIONS
Among patients dependent on hemodialysis in the United States, both short-term and longer-term use of opioid analgesics were associated with hip fracture events.
Identifiants
pubmed: 32371535
pii: ASN.2019090904
doi: 10.1681/ASN.2019090904
pmc: PMC7269355
doi:
Substances chimiques
Analgesics, Opioid
0
Gabapentin
6CW7F3G59X
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1325-1334Informations de copyright
Copyright © 2020 by the American Society of Nephrology.
Références
J Cell Biochem. 1994 Jul;55(3):334-9
pubmed: 7962165
Drug Alcohol Depend. 2006 Feb 1;81(2):103-7
pubmed: 16023304
JAMA. 2009 Oct 14;302(14):1573-9
pubmed: 19826027
Am J Kidney Dis. 2014 Jan;63(1):171-3
pubmed: 24145020
J Bone Miner Metab. 2017 Jan;35(1):99-107
pubmed: 26747613
Epidemiology. 2011 Sep;22(5):704-12
pubmed: 21747285
Nephrol Nurs J. 2012 Jan-Feb;39(1):13-9; quiz 20
pubmed: 22480048
Addiction. 2011 Feb;106(2):349-54
pubmed: 20955216
Neuroendocrinology. 2000 Sep;72(3):187-94
pubmed: 11025413
PLoS One. 2015 Jun 01;10(6):e0128232
pubmed: 26030421
Osteoporos Int. 2012 Apr;23(4):1255-65
pubmed: 21710339
Clin J Am Soc Nephrol. 2016 Jun 6;11(6):1063-72
pubmed: 27026521
Clin Pharmacol Ther. 1991 Sep;50(3):308-13
pubmed: 1680593
Biometrics. 1999 Sep;55(3):718-26
pubmed: 11314998
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2014 Dec;39(12):1292-8
pubmed: 25544164
J Am Soc Nephrol. 2018 Jul;29(7):1970-1978
pubmed: 29871945
Clin J Am Soc Nephrol. 2009 Jun;4(6):1089-96
pubmed: 19423571
J Bone Miner Res. 1998 Jan;13(1):88-95
pubmed: 9443794
Stat Methods Med Res. 2007 Jun;16(3):219-42
pubmed: 17621469
Am J Kidney Dis. 2020 Mar;75(3):351-360
pubmed: 31606233
Mayo Clin Proc. 2009 Jul;84(7):613-24
pubmed: 19567715
J Bone Miner Metab. 2017 May;35(3):289-297
pubmed: 27023332
Regul Pept. 1988 Apr;20(4):305-10
pubmed: 3368581
Eur J Endocrinol. 2018 Oct 01;179(4):R183-R196
pubmed: 30299887
Am J Kidney Dis. 2004 Oct;44(4):672-9
pubmed: 15384018
Bone. 2008 Mar;42(3):535-46
pubmed: 18166509
Drug Alcohol Depend. 2006 Dec 1;85(3):258-62
pubmed: 16860495
Clin J Am Soc Nephrol. 2018 Oct 8;13(10):1534-1541
pubmed: 30262672
Pharmacogenomics J. 2017 Jan;17(1):61-68
pubmed: 26667830
Clin J Am Soc Nephrol. 2014 Jul;9(7):1328-35
pubmed: 24509298
Am J Kidney Dis. 2003 Dec;42(6):1239-47
pubmed: 14655196
Arch Intern Med. 2004 Feb 9;164(3):338; author reply 338
pubmed: 14769633
Am J Kidney Dis. 2013 Oct;62(4):747-54
pubmed: 23631997
Obstet Gynecol. 1990 Jun;75(6):998-1000
pubmed: 2342747
Clin J Am Soc Nephrol. 2013 Aug;8(8):1336-42
pubmed: 23660182
Calcif Tissue Int. 2011 Sep;89(3):228-33
pubmed: 21698454
Clin J Am Soc Nephrol. 2018 May 7;13(5):746-753
pubmed: 29674340
J Pain. 2002 Oct;3(5):377-84
pubmed: 14622741