strong painkillers
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The association between the risk of hip fractures and the use of strong painkillers in patients with dementia was investigated in a recent study published in the journal Pain.

Pain is a common condition in people who have Alzheimer’s dementia and other forms of dementia. Approximately half of dementia patients suffer from chronic pain, and studies show that the incidence of pain in these patients increases with age. For patients with more severe pain, strong painkillers such as opioid pain relievers are needed. It’s reported that 28% of community-living patients with dementia use opioid pain relievers.

Older people are more susceptible to the side effects of opioid painkillers because of the natural age-related changes in the body’s metabolism and handling of drugs. This puts older people who use opioids at risk of increased drowsiness, and other cognitive impairments. This can increase their risk of falls and therefore fractures.

It is already known that dementia patients have an increased risk of hip fractures, however, the role of opioid use in this risk has not yet been studied. To explore this, researchers in Finland studied whether opioid use is associated with hip fractures in dementia patients living in the community. They published their results in the journal Pain.

The researchers looked at a group of 70,718 people living in the community who were diagnosed with Alzheimer’s dementia in Finland. They included patients diagnosed with Alzheimer’s between 2010 and 2011, and excluded patients who were frequent opioid users, had a long stay in hospital, or had a hip fracture in the past.

The opioid users were matched in a 1:1 ratio to a non-opioid user based on age, gender, and time since their dementia diagnosis. The opioids were classified as weak opioids (such as codeine and tramadol), buprenorphine, and strong opioids (such as morphine, oxycodone, and hydromorphone). Only the first diagnosis of hip fracture was included in the analysis.

The study found that the risk of hip fractures was increased in Alzheimer’s disease patients who were using opioids for treating pain. The hip fracture risk was also observed to increase with higher doses of opioids. The significantly increased risk was highest during the first two months of use, but was weakened and not significant with longer duration of use. This is consistent with reports that state people can become tolerant to opioid side effects with continued and prolonged use.

This study included a large community population of patients with Alzheimer’s disease, thus making the results generalizable to these types of patients. They also matched opioid and non-opioid users based on the major risk factors for hip fracture, and excluded patients who commonly used opioids to eliminate bias related to users who may have become tolerant to opioid side effects. However, the study didn’t have information on the other lifestyle risk factors that can contribute to hip fractures.

In light of these findings, the study suggests that further research to investigate whether a lower starting dose and slower dose increases when starting a strong painkiller can help to reduce or prevent hip fractures in Alzheimer’s patients.

Written by Maggie Leung, PharmD

References:

  1. Taipale, H., Hamina, A., Karttunen, N., Koponen, M., Tanskanen, A., Tiihonen, J., . . . Tolppanen, A. (2018). Incident opioid use and risk of hip fracture among persons with Alzheimer disease. Pain, 1.doi:10.1097/j.pain.0000000000001412
  2. Hartikainen, S. (2018, November 26). Strong painkillers increase the risk of hip fracture among persons with Alzheimer’s disease. Retrieved from https://www.eurekalert.org/pub_releases/2018-11/uoef-spi112618.php
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