Daily pain medications are a normal part of most seniors’ daily life. But not all pain medications are equal. A recent study published in the Journal of Bone and Mineral Research (1) has demonstrated that the pain medication tramadol (2) increases the risk of hip fractures significantly in older people.
The results were most categorical when compared with meds such as codeine or commonly used nonsteroidal anti-inflammatory drugs (NSAIDs).
The illuminating research was conducted in the UK and involved 146,956 patients over 50 years of age. The large scope of the study was made possible by the patients’ enrollment in The Health Improvement Network (THIN) (3). The study was also conducted over an extended period of time – between 2000 and 2017 with all patients suffering from various noncancer-related pains and without having any prior opioid consumption history.
The study compared the “hazard ratio” or HR of tramadol compared to codeine, naproxen, ibuprofen, NSAIDs, celecoxib, and etoricoxib. The hazard ratio for tramadol was higher compared to all of its alternatives – 1.28 compared to codeine (in other words, for every 1 hip fracture with a patient on codeine, 1.28 patients on tramadol had similar accidents), 1.69 compared to naproxen, 1.65 compared to ibuprofen, 1.85 to celecoxib, and 1.96 to etoricoxib.
Jie Wei, Ph.D., an author of the study and an associate professor of epidemiology at Xiangya Hospital, Central South University, China, told Medscape Medical News (4) that “Considering the significant impact of hip fracture on morbidity, mortality, and healthcare cost, our results point to the need to consider tramadol’s associated risk of fracture in clinical practice and treatment guidelines,”
Shailendra Singh, MD also chipped in and said that the “article clearly reinforces [prior] knowledge…that opiates are associated with an increased risk of falls and fractures.”
This negative focus on opioids is becoming more and more common in the medical spheres as Singh also mentions. The American Geriatric Society BEERS criteria for inappropriate drugs for the elderly (5), for example, recommends that both tramadol and opioids be avoided as they increase the risk of falls and bone fractures.
Singh herself is a rheumatology medical director of the White River Medical Center in Batesville, Arkansas (6), and isn’t involved in Jie Wei’s study but like many other rheumatology professionals, she supports the study’s findings.
If we add these considerations to the myriad of other opioid-related problems that are currently ravaging people in the U.S. (7), using tramadol or other opioids for pain relief becomes even more ill-advised, particularly for senior citizens.