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Commonly Initiated Opioids and Risk of Fracture Hospitalizations in United States Nursing Homes

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Abstract

Objectives

The aim of this study was to estimate the comparative safety of initiating commonly used opioids among older, long-stay United States nursing home residents with fracture hospitalizations.

Methods

We conducted a new-user retrospective cohort study of nursing home residents initiating short-acting oxycodone, hydrocodone, or tramadol by merging the 2011–2013 Minimum Data Set 3.0 to Medicare hospitalization and pharmacy claims. Residents (≥ 65 years, no cancer or hospice use) contributed treatment episodes (> 120 days with no prior opioid claims) and were followed for 180 days until incident fracture hospitalization (hip, femur, humerus, pelvis, radius/ulna), death (competing risk), treatment changes (e.g., discontinuation), or administrative censoring. Competing risks models with inverse probability of treatment weighting were used to estimate subdistribution hazard ratios (HRSD) and 95% confidence intervals (CI).

Results

Overall, 110,862 residents contributed 134,432 treatment episodes: 14,373 oxycodone; 69,182 hydrocodone; and 50,877 tramadol initiators. The incidences of fracture hospitalizations per 100 person-years were 9.4 (95% CI 7.5–11.7) for oxycodone, 7.9 (95% CI 7.1–8.8) for hydrocodone, and 5.0 (95% CI 4.3–5.7) for tramadol initiators. In weighted models, oxycodone initiators had a similar rate of fractures to hydrocodone initiators (HRSD 1.08, 95% CI 0.79–1.48). Tramadol initiators had lower fracture rates than hydrocodone initiators (HRSD 0.67, 95% CI 0.56–0.80).

Conclusions

The lower rate of fractures that we documented among tramadol initiators compared with hydrocodone initiators is consistent, albeit attenuated compared with prior studies among community-dwelling older adults. However, overall fracture rates were lower than in community settings, potentially due to the limited risk of falling in this population with limited mobility.

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Authors and Affiliations

  1. Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Road North, Worcester, MA, 01655, USA

    Jacob N. Hunnicutt, Shao-Hsien Liu, Christine M. Ulbricht, Jennifer Tjia & Kate L. Lapane

  2. Department of Family Medicine, Alpert Medical School, Brown University, Memorial Hospital of Rhode Island, Providence, RI, USA

    Anne L. Hume

  3. Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA

    Anne L. Hume

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  1. Jacob N. Hunnicutt
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Corresponding author

Correspondence to Kate L. Lapane.

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Conflict of interest

JNH, ALHSHL, CMU, JT and KLL have no conflicts of interest to declare.

Ethical approval

This study used routinely collected administrative and claims data and was approved by the University of Massachusetts Medical School Institutional Review Board.

Funding

This work was funded by the following National Institute of Health Grants: 1F31AG056078-01, 1R56NR015498-01, R01NR016977.

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Hunnicutt, J.N., Hume, A.L., Liu, SH. et al. Commonly Initiated Opioids and Risk of Fracture Hospitalizations in United States Nursing Homes. Drugs Aging 35, 925–936 (2018). https://doi.org/10.1007/s40266-018-0583-x

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