Kazuki Yoshida1,2,3, Zhi Yu3,4, Gail A Greendale5, Kristine Ruppert6, Yinjuan Lian6, Sara K Tedeschi3, Tzu-Chieh Lin3, Sebastien Haneuse2, Robert J Glynn2,7, Sonia Hernández-Díaz1, Daniel H Solomon3,7. 1. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 2. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 3. Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, USA. 4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 5. Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. 6. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA. 7. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Abstract
PURPOSE: To examine the effects of analgesics on bone mineral density (BMD), which have not been examined in a longitudinal study with multiple measurements. METHODS: We investigated changes in BMD associated with new use of analgesics in a prospective longitudinal cohort of mid-life women. BMD and medication use were measured annually. We compared BMD among new users of acetaminophen, NSAIDs, and opioids. Adjustment for baseline covariates was conducted through propensity score matching weights. On-treatment analysis was conducted with inverse probability of censoring weights. Analysis based on the initial treatment group was also conducted to provide insights into selection bias. Repeated BMD measurements were examined with generalized estimating equations. RESULTS: We identified 71 acetaminophen new users, 659 NSAID new users, and 84 opioid new users among 2365 participants. In the on-treatment analysis, the opioid group in comparison to the acetaminophen group had an additional average BMD decline of -0.06% [-1.24, 1.11] per year in the spine and -0.45% [-1.51, 0.61] per year in the femoral neck. BMD mean trajectories over time suggested a fifth-year decline in the opioid persistent users compared with other 2 groups. In the initial treatment group analysis, all 3 groups showed similar trajectories. CONCLUSION: The BMD decline over time was similar among the 3 groups. However, 5 years of continuous opioid use may be associated with a greater BMD decline than 5 years on other analgesics. Further studies examining the relationship between very long-term persistent opioid use and BMD are warranted.
PURPOSE: To examine the effects of analgesics on bone mineral density (BMD), which have not been examined in a longitudinal study with multiple measurements. METHODS: We investigated changes in BMD associated with new use of analgesics in a prospective longitudinal cohort of mid-life women. BMD and medication use were measured annually. We compared BMD among new users of acetaminophen, NSAIDs, and opioids. Adjustment for baseline covariates was conducted through propensity score matching weights. On-treatment analysis was conducted with inverse probability of censoring weights. Analysis based on the initial treatment group was also conducted to provide insights into selection bias. Repeated BMD measurements were examined with generalized estimating equations. RESULTS: We identified 71 acetaminophen new users, 659 NSAID new users, and 84 opioid new users among 2365 participants. In the on-treatment analysis, the opioid group in comparison to the acetaminophen group had an additional average BMD decline of -0.06% [-1.24, 1.11] per year in the spine and -0.45% [-1.51, 0.61] per year in the femoral neck. BMD mean trajectories over time suggested a fifth-year decline in the opioid persistent users compared with other 2 groups. In the initial treatment group analysis, all 3 groups showed similar trajectories. CONCLUSION: The BMD decline over time was similar among the 3 groups. However, 5 years of continuous opioid use may be associated with a greater BMD decline than 5 years on other analgesics. Further studies examining the relationship between very long-term persistent opioid use and BMD are warranted.
Authors: Kazuki Yoshida; Sonia Hernández-Díaz; Daniel H Solomon; John W Jackson; Joshua J Gagne; Robert J Glynn; Jessica M Franklin Journal: Epidemiology Date: 2017-05 Impact factor: 4.822
Authors: Dennis M Black; Pierre D Delmas; Richard Eastell; Ian R Reid; Steven Boonen; Jane A Cauley; Felicia Cosman; Péter Lakatos; Ping Chung Leung; Zulema Man; Carlos Mautalen; Peter Mesenbrink; Huilin Hu; John Caminis; Karen Tong; Theresa Rosario-Jansen; Joel Krasnow; Trisha F Hue; Deborah Sellmeyer; Erik Fink Eriksen; Steven R Cummings Journal: N Engl J Med Date: 2007-05-03 Impact factor: 91.245
Authors: Roger Chou; Gilbert J Fanciullo; Perry G Fine; Jeremy A Adler; Jane C Ballantyne; Pamela Davies; Marilee I Donovan; David A Fishbain; Kathy M Foley; Jeffrey Fudin; Aaron M Gilson; Alexander Kelter; Alexander Mauskop; Patrick G O'Connor; Steven D Passik; Gavril W Pasternak; Russell K Portenoy; Ben A Rich; Richard G Roberts; Knox H Todd; Christine Miaskowski Journal: J Pain Date: 2009-02 Impact factor: 5.820
Authors: Laura D Carbone; Frances A Tylavsky; Jane A Cauley; Tamara B Harris; Thomas F Lang; Douglas C Bauer; Karen D Barrow; Stephen B Kritchevsky Journal: J Bone Miner Res Date: 2003-10 Impact factor: 6.741
Authors: Jacob N Hunnicutt; Anne L Hume; Shao-Hsien Liu; Christine M Ulbricht; Jennifer Tjia; Kate L Lapane Journal: Drugs Aging Date: 2018-10 Impact factor: 3.923