Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2013 Mar;61(3):335-40.
doi: 10.1111/jgs.12148. Epub 2013 Mar 1.

Greater number of narcotic analgesic prescriptions for osteoarthritis is associated with falls and fractures in elderly adults

Lydia Rolita  1 , Adele Spegman, Xiaoqin Tang, Bruce N Cronstein
Affiliations
Comparative Study

Greater number of narcotic analgesic prescriptions for osteoarthritis is associated with falls and fractures in elderly adults

Lydia Rolita et al. J Am Geriatr Soc. 2013 Mar.

Abstract

Objectives: To evaluate the changes in types of medications prescribed for pain before and after withdrawal of certain selective cyclooxygenase 2 (COX-2) inhibitors in 2004 and to determine whether there was an association with fall events in elderly adults with a diagnosis of osteoarthritis (OA).

Design: A nested case-control design using electronic medical records compiled between 2001 and 2009.

Setting: Electronic medical records for care provided in an integrated health system in rural Pennsylvania over a 9-year period (2001-09), the midpoint of which rofecoxib and valdecoxib were pulled from the market.

Participants: Thirteen thousand three hundred fifty-four individuals aged 65 to 89 with a diagnosis of OA.

Measurements: The incidence of falls and fractures was examined in relation to analgesics prescribed: narcotics, COX-2 inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs). The comparison sample of individuals who did not fall was matched 3:1 with those who fell according to age, sex, and comorbidity.

Results: Narcotic analgesic prescriptions were associated with a significantly greater risk of falls and fractures. The likelihood of experiencing a fall/fracture was higher in participants prescribed narcotic analgesics than those prescribed a COX-2 inhibitor (odds ratio (OR) = 3.3, 95% confidence interval (CI) = 2.5-4.3) or NSAID (OR = 4.1, 95% CI = 3.7-4.5).

Conclusion: Use of narcotic analgesics is associated with risk of falls and fractures in elderly adults with OA, an observation that suggests that the current guidelines for the treatment of pain, which include first-line prescription of narcotics, should be reevaluated.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest

Dr. Cronstein would like to disclose the following, none of which are relevant to this work: Intellectual property: patents on use of adenosine A2A receptor antagonists to promote wound healing and use of A2A receptor antagonists to inhibit fibrosis. Patent on use of adenosine A1 receptor antagonists to treat osteoporosis and other diseases of bone. Patent on use of adenosine A1 and A2B Receptor antagonists to treat fatty liver. Patent on the use of adenosine A2A receptor agonists to prevent prosthesis loosening.

Figures

Figure 1
Figure 1
Prescription trends for the 3 analgesic groups
Figure 2
Figure 2
Incidence of fall/fracture events for the 3 analgesic groups
See this image and copyright information in PMC

Comment in

References

    1. O'Loughlin JL, Robitaille Y, Boivin JF, et al. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol. 1993;37:342–354. - PubMed
    1. Sterling DA, O'Connor JA, Bonadies J, et al. Geriatric falls: Injury severity is high and disproportionate to mechanism. J Trauma. 2001;50:116–119. - PubMed
    1. Tinetti ME, Williams CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med. 1997;337:1279–1284. - PubMed
    1. Vellas BJ, Wayne SJ, Romero LJ, et al. Fear of falling and restriction of mobility in elderly fallers. Age Ageing. 1997;26:189–193. - PubMed
    1. Stevens JA, Corso PS, et al. The costs of fatal and non-fatal falls among older adults. Inj Prev. 2006;12:290–295. - PMC - PubMed

Publication types

MeSH terms

Substances