Fractures

Researchers Identify High Fracture Risk With Tramadol Use

The clinical practice guidelines on tramadol use need to be revisited, according to authors of a new study. This determination comes after the researchers found that the initiation of tramadol is associated with a higher risk of hip fracture among adults 50 years or older.1

“Several professional organizations have recommended tramadol as one of the first‐line or second‐line therapies for patients with chronic noncancer pain, and its prescription has been increasing rapidly worldwide; however, the safety profile of tramadol, such as risk of fracture, remains unclear,” the researchers wrote.

To evaluate the association between tramadol use and hip fracture risk, the researchers assessed data on persons aged 50 years or older in the United Kingdom without a history of hip fracture, cancer, or opioid use disorder from The Health Improvement Network (THIN) patient database (2000–2017). The patients’ mean age was 65.7 years, and 56.9% of them were women.

The researchers grouped the patients into sequential propensity score–matched cohorts based on whether patients initiated treatment with tramadol or one of the following medications: codeine (n=146,956), naproxen (n=115,109), ibuprofen (n=107,438), celecoxib (n=43,130), or etoricoxib (n=27,689).

During the 1‐year follow‐up, participants in the tramadol cohort had a total of 518 hip fractures (3.7/1000 person‐years). Meanwhile, participants in the codeine cohort experienced a total of 401 hip fractures (2.9/1000 person‐years). Compared with codeine, the hazard ratio of hip fracture for tramadol was 1.28 (95% CI, 1.13-1.46). 

The tramadol cohort also had a higher risk of hip fracture than the naproxen cohort (2.9/1000 person‐years vs 1.7/1000 person‐years); the ibuprofen cohort (3.4/1000 person‐years vs 2.0/1000 person‐years); the celecoxib cohort (3.4/1000 person‐years vs 1.8/1000 person‐years); and the etoricoxib cohort (2.9/1000 person‐years vs 1.5/1000 person‐years).

“Considering the significant impact of hip fracture on morbidity, mortality, and health care costs, our results point to the need to consider tramadol’s associated risk of fracture in clinical practice and treatment guidelines,” study coauthor Guanghua Lei, MD, PhD, said in a press release.2

—Colleen Murphy

References:

  1. Wei J, Lane NE, Bolster MB, et al. Association of tramadol use with risk of hip fracture [published online February 5, 2020]. J Bone Miner Res. doi:10.1002/jbmr.3935.
  2. Does tramadol increase hip fracture risk? [press release]. Wiley; February 5, 2020. https://newsroom.wiley.com/press-release/journal-bone-and-mineral-research/does-tramadol-increase-hip-fracture-risk. Accessed February 5, 2020.