Tramadol use is associated with increased risk for hip fracture compared with other commonly prescribed pain medications, according to study results published in the Journal of Bone and Mineral Research.

Tramadol is commonly prescribed for pain management due to a relatively lower risk for adverse effects and addiction. However, tramadol use may be associated with an increased risk for falls, which may in turn increase fracture risk in older individuals. Using data obtained from The Health Improvement Network (THIN) in the United Kingdom, researchers aimed to compare the risk for hip fracture in adults ≥50 years of age who received tramadol or other commonly prescribed pain medications in 5 propensity score-matched studies.

A cohort of 146,956 tramadol users was matched 1:1 with codeine users (both approximately 57.5% women). Among the tramadol users, 518 cases of hip fracture (3.7 per 1000 person-years) occurred compared with 401 cases (2.9 per 1000 person-years) in the codeine group (hazard ratio [HR], 1.28; 95% CI, 1.13-1.46). The increased risk for fracture was observed for both men (HR, 1.60; 95% CI, 1.24-2.06) and women (HR, 1.18; 95% CI, 1.02-1.38).

The risk for hip fracture in the tramadol cohort was also higher than that in users of naproxen (HR, 1.69; 95% CI, 1.41-2.03), ibuprofen (HR, 1.65; 95% CI, 1.39-1.96), celecoxib (HR, 1.85; 95% CI, 1.40-2.44), and etoricoxib (HR, 1.96; 95% CI, 1.34-2.87). For all comparisons, the increase in fracture risk was higher in men than in women.

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The study authors noted that tramadol use has been linked to neurologic disturbances, including seizures, dizziness, and delirium, which may increase the risk of falling. They suggested that the relationship between tramadol use and hip fracture risk may be at least partially mediated by tramadol’s effect on fall risk. The observational nature of the study, however, prevented the researchers from ruling out the potential effects of confounding factors that may contribute to fracture risk.

“[W]e found that the initiation of tramadol was associated with a higher risk of hip fracture than the initiation of codeine and commonly used [nonsteroidal anti-inflammatory drugs],” the researchers concluded. “Considering the significant impact of hip fracture on morbidity, mortality, and health care cost, our results point to the need to consider tramadol’s associated risk of fracture in clinical practice and treatment guidelines.”

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Reference

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