Chandan Vangala1,2,3, Jingbo Niu4,5, Maria E Montez-Rath6, Jingyin Yan4, Sankar D Navaneethan4,7, Aanand D Naik8, Wolfgang C Winkelmayer4. 1. Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas chandan.vangala@bcm.edu. 2. Clinical Effectiveness and Population Health, Houston Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas. 3. Section of Nephrology & Solid Organ Transplant, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. 4. Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas. 5. Methodology & Analytics Core, Houston Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas. 6. Division of Nephrology, Stanford University School of Medicine, Palo Alto, California. 7. Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. 8. Education & Training Core, Houston Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas.
Abstract
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.
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.
Authors: J L Pérez-Castrillón; J M Olmos; J J Gómez; A Barrallo; J A Riancho; L Perera; C Valero; J A Amado; J González-Macías Journal: Neuroendocrinology Date: 2000-09 Impact factor: 4.914
Authors: Frank Gotthardt; Christine Huber; Clara Thierfelder; Leticia Grize; Marius Kraenzlin; Claude Scheidegger; Christian Meier Journal: J Bone Miner Metab Date: 2016-01-08 Impact factor: 2.626
Authors: Mark B Lockwood; Michael J Fischer; Kimberly Silva; Blanca N Contreras; Guillermo Zamora; Amanda Goldstein; Monya Meinel; Christopher Holden; James Lash; Alana Steffens; Ardith Doorenbos Journal: Contemp Clin Trials Commun Date: 2022-09-05