05. tbl. 103. árg. 2017

Do opioids, sedatives and proton-pump inhibitors increase the risk of fractures?

Auka ópíóíðar, róandi lyf, svefnlyf og prótónupumpuhemlar hættu á beinbrotum?

Introduction: A pharmacoepidemiological study was conducted to analyse the relationship between bone fracture and the use of certain drugs.

Material/methods: The study includes patients 40 years and older, diagnosed with bone fractures in the Emergency Department of Landspitali University Hospital in Reykjavik, Iceland, during a 10-year period (2002-2011). Also were included those who picked up from a pharmacy 90 DDD or more per year of the drugs included in the study in the capital region of Iceland during same period. Opiates, benzodiazepines/hypnotics (sedatives) were compared with HMG-CoA reductase inhibitors (statins), non-steroid anti-inflammatory drugs (NSAID) and beta blockers. Proton-pump inhibitors (PPI) and histamine H2-antagonists were also examined. To examine the association between above drugs and fractures the data from electronic hospital database were matched  to the prescription database run by the Directorate of Health.

Results: A total of 29,056 fractures in 22,891 individuals were identified. The females with fractures were significantly older and twice as many, compared to males. The odds ratio (OR) for fractures was not significantly different between the NSAID, statins and beta blockers. OR for opiates showed almost double increased risk of fractures, 40% increased risk for sedatives and 30% increased risk for PPIs compared to beta blockers. No increased fracture-risk was noted in patients taking H2 antagonists.

Conclusion: This study shows a relationship between the use of opiates, sedatives and bone fractures. The incidence of fractures was also increased in patients taking PPIs which is interesting in the light of the wide-spread use of PPIs in the community.

Table I The number and distribution of fractures in the study by age and gender of the patients.

Table II Number of individuals (n) with fractures.

Table III Patient-years (n) without fractures.

Table IV Number of fractures for men and women for each class of the drugs.

Table VI Logistic regression was applied, with fracture as the dependent variable and age, gender and medicines as the independent variables.

Table V The table shows OR (95% CI) for the risk of fractures when columns are compared with rows. Crude chi-square was used to assess the OR.

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