Association of Opioids with Falls, Fractures, and Physical Performance among Older Men with Persistent Musculoskeletal Pain

Erin E. Krebs, Misti Paudel, Brent C. Taylor, Douglas C. Bauer, Howard A. Fink, Nancy E Lane, Kristine E. Ensrud, The Osteoporotic Fractures In Men (Mros) Study Research Group For The Osteoporotic Fractures In Men (Mros) Study Research Group

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Although older adults are disproportionately affected by painful musculoskeletal conditions and receive more opioid analgesics than persons in other age groups, insufficient evidence is available regarding opioid harms in this age group. Objective: To examine longitudinal relationships between opioid use and falls, clinical fractures, and changes in physical performance. We hypothesized that opioid use would be associated with greater risks of falling and incident clinical fractures and greater declines in physical performance. Design: We analyzed data from the Osteoporotic Fractures in Men Study (MrOS), a large prospective longitudinal cohort study. Participants completed baseline visits from 2000 to 2002 and were followed for 9.1 (SD 4.0) years. Participants: MrOS enrolled 5994 community-dwelling men ≥ 65 years of age. The present study included 2902 participants with back, hip, or knee pain most or all of the time at baseline. Main Measures: The exposure of interest was opioid use, defined at each visit as participant-reported daily or near-daily use of any opioid-containing analgesic. Among patients, 309 (13.4 %) reported opioid use at one or more visits. Participants were queried every 4 months about falls and fractures. Physical performance scores were derived from tests of grip strength, chair stands, gait speed, and dynamic balance. Key Results: In the main analysis, the adjusted risk of falling did not differ significantly between opioid use and non-use groups (RR 1.10, 95 % CI 0.99, 1.24). Similarly, adjusted rates of incident clinical fracture did not differ between groups (HR 1.13, 95 % CI 0.94, 1.36). Physical performance was worse at baseline for the opioid use group, but annualized change in physical performance scores did not differ between groups (−0.022, 95 % CI −0.138, 0.093). Conclusions: Additional research is needed to determine whether opioid use is a marker of risk or a cause of falls, fractures, and progressive impairment among older adults with persistent pain.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalJournal of General Internal Medicine
DOIs
StateAccepted/In press - Jan 11 2016
Externally publishedYes

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Musculoskeletal Pain
Opioid Analgesics
Accidental Falls
Age Groups
Independent Living
Pain
Osteoporotic Fractures
Hand Strength
Longitudinal Studies
Hip
Knee
Cohort Studies

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Krebs, E. E., Paudel, M., Taylor, B. C., Bauer, D. C., Fink, H. A., Lane, N. E., ... For The Osteoporotic Fractures In Men (Mros) Study Research Group, T. O. F. I. M. M. S. R. G. (Accepted/In press). Association of Opioids with Falls, Fractures, and Physical Performance among Older Men with Persistent Musculoskeletal Pain. Journal of General Internal Medicine, 1-7. https://doi.org/10.1007/s11606-015-3579-9

Association of Opioids with Falls, Fractures, and Physical Performance among Older Men with Persistent Musculoskeletal Pain. / Krebs, Erin E.; Paudel, Misti; Taylor, Brent C.; Bauer, Douglas C.; Fink, Howard A.; Lane, Nancy E; Ensrud, Kristine E.; For The Osteoporotic Fractures In Men (Mros) Study Research Group, The Osteoporotic Fractures In Men (Mros) Study Research Group.

In: Journal of General Internal Medicine, 11.01.2016, p. 1-7.

Research output: Contribution to journalArticle

Krebs, EE, Paudel, M, Taylor, BC, Bauer, DC, Fink, HA, Lane, NE, Ensrud, KE & For The Osteoporotic Fractures In Men (Mros) Study Research Group, TOFIMMSRG 2016, 'Association of Opioids with Falls, Fractures, and Physical Performance among Older Men with Persistent Musculoskeletal Pain', Journal of General Internal Medicine, pp. 1-7. https://doi.org/10.1007/s11606-015-3579-9
Krebs, Erin E. ; Paudel, Misti ; Taylor, Brent C. ; Bauer, Douglas C. ; Fink, Howard A. ; Lane, Nancy E ; Ensrud, Kristine E. ; For The Osteoporotic Fractures In Men (Mros) Study Research Group, The Osteoporotic Fractures In Men (Mros) Study Research Group. / Association of Opioids with Falls, Fractures, and Physical Performance among Older Men with Persistent Musculoskeletal Pain. In: Journal of General Internal Medicine. 2016 ; pp. 1-7.
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abstract = "Background: Although older adults are disproportionately affected by painful musculoskeletal conditions and receive more opioid analgesics than persons in other age groups, insufficient evidence is available regarding opioid harms in this age group. Objective: To examine longitudinal relationships between opioid use and falls, clinical fractures, and changes in physical performance. We hypothesized that opioid use would be associated with greater risks of falling and incident clinical fractures and greater declines in physical performance. Design: We analyzed data from the Osteoporotic Fractures in Men Study (MrOS), a large prospective longitudinal cohort study. Participants completed baseline visits from 2000 to 2002 and were followed for 9.1 (SD 4.0) years. Participants: MrOS enrolled 5994 community-dwelling men ≥ 65 years of age. The present study included 2902 participants with back, hip, or knee pain most or all of the time at baseline. Main Measures: The exposure of interest was opioid use, defined at each visit as participant-reported daily or near-daily use of any opioid-containing analgesic. Among patients, 309 (13.4 {\%}) reported opioid use at one or more visits. Participants were queried every 4 months about falls and fractures. Physical performance scores were derived from tests of grip strength, chair stands, gait speed, and dynamic balance. Key Results: In the main analysis, the adjusted risk of falling did not differ significantly between opioid use and non-use groups (RR 1.10, 95 {\%} CI 0.99, 1.24). Similarly, adjusted rates of incident clinical fracture did not differ between groups (HR 1.13, 95 {\%} CI 0.94, 1.36). Physical performance was worse at baseline for the opioid use group, but annualized change in physical performance scores did not differ between groups (−0.022, 95 {\%} CI −0.138, 0.093). Conclusions: Additional research is needed to determine whether opioid use is a marker of risk or a cause of falls, fractures, and progressive impairment among older adults with persistent pain.",
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AU - Fink, Howard A.

AU - Lane, Nancy E

AU - Ensrud, Kristine E.

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