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Osteoporosis International

, Volume 23, Issue 4, pp 1255–1265 | Cite as

Effects of paracetamol, non-steroidal anti-inflammatory drugs, acetylsalicylic acid, and opioids on bone mineral density and risk of fracture: results of the Danish Osteoporosis Prevention Study (DOPS)

  • P. Vestergaard
  • P. Hermann
  • J.-E. B. Jensen
  • P. Eiken
  • L. Mosekilde
Original Article

Abstract

Summary

Pain medication has been associated with fractures. We found higher weight in paracetamol and non-steroidal anti-inflammatory drugs (NSAID) users and lower vitamin D levels in opioid and acetylsalicylic acid users. None of the pain medications influenced bone mineral density or loss. NSAID were associated with an increased fracture risk.

Introduction

To study the effects of use of paracetamol, non-steroidal anti-inflammatory drugs (NSAID), acetylsalicylic acid (ASA), and opioids on bone mineral density (BMD) and risk of fractures.

Methods

Two-thousand sixteen perimenopausal women followed for 10 years as part of a partly randomised comprehensive cohort study on hormone therapy (HT). BMD was measured at baseline and after 10 years by DXA (Hologic).

Results

Paracetamol users were heavier (70.4 ± 13.4 vs. 67.7 ± 11.9 kg, 2p < 0.01) than non-users. NSAID users were heavier (71.6 ± 15.6 vs. 67.8 ± 11.9 kg, 2p = 0.04) than non-users. ASA users had lower 25-hydroxy-vitamin D (25OHD) levels (21.9 ± 9.3 vs. 25.3 ± 12.4 ng/ml, 2p < 0.01) than non-users. Opioid users had lower 25OHD (21.4 ± 8.4 vs. 25.2 ± 12.3 ng/ml) and lower intake of vitamin D (2.2 ± 1.1 vs. 3.1 ± 3.0 μg/day, 2p < 0.01) than non-users. Despite these differences, no baseline differences were present in spine, hip, forearm or whole body BMD. Over 10 years, no differences were present in BMD alterations except a small trend towards a higher BMD gain in the spine in users of paracetamol, NSAID, ASA, and opioids compared to non-exposed. After adjustment, NSAID exposed sustained more fractures (HR = 1.44, 95% CI 1.07–1.93) than non-users. For users of paracetamol and opioids, a non-significant trend towards more fractures was present after adjustment. For ASA users, no excess risk of fractures was present.

Conclusion

Significant differences exist between subjects exposed to pain medications and non-users. Despite an absence of an effect over time on BMD, users of NSAID experienced more fractures than expected. The reasons for this have to be explored in further studies.

Keywords

Acetylsalicylic acid Bone mineral Fracture Non-steroidal anti-inflammatory drugs Opioid Paracetamol 

Notes

Financial support

The study was made possible through financial support from the A.P. Møller Foundation (Fonden til Lægevidenskabens Fremme), and by Karen Elise Jensen’s Foundation, the Danish Medical Research Council. Novo Nordisk Denmark, Novartis Denmark, and Leo Denmark provided the study medication free of charge. None of these had any influence on study design and conduct.

Conflicts of interest

None.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • P. Vestergaard
    • 1
    • 5
  • P. Hermann
    • 2
  • J.-E. B. Jensen
    • 3
  • P. Eiken
    • 4
  • L. Mosekilde
    • 1
  1. 1.Department of Endocrinology and Internal Medicine (MEA)Aarhus University HospitalAarhusDenmark
  2. 2.Department of Endocrinology MOdense University HospitalOdenseDenmark
  3. 3.Department of EndocrinologyHvidovre University HospitalCopenhagenDenmark
  4. 4.Department of Cardiology and Endocrinology, Hillerød HospitalHillerødDenmark
  5. 5.The Osteoporosis ClinicAarhus University Hospital THGAarhus CDenmark

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