Fracture risk and opioid use in patients aged 17–64 years: An analysis of administrative claims data

Abstract

AbstractStudy ObjectiveThe objective of this work is to describe the risk of fracture in adults aged 17 to 64 years across categories of daily opioid dose.DesignA retrospective analysis of insurance claims data.Data sourceInformation from a private health insurance provider for the years 2003–2014 for enrolled individuals living in Iowa.PatientsPatients who were aged 17 to 64 years and prescribed an opioid were followed for the length of opioid treatment plus 30 days to determine whether a fracture occurred.MeasurementsAverage daily morphine milligram equivalent (MME) was determined for patients who received a prescription for opioids. The outcome of interest was incident fracture following opioid treatment initiation. Cox proportional hazard models were used to compare the risk of fracture across categorical groups of average daily MME. Inverse probability weighting was used to control for patient‐level variables.Main ResultsIn total, 316,024 individual patients were identified in the administrative claims data as having an opioid prescription from 2003 to 2014, and 3038 fractures occurred during follow‐up (9.6 fractures per 1000 opioid‐prescribed patients). Relative to the lowest quartile of prescribed opioid (⟨22 MME), patients in each higher prescribed level were more likely to experience a fracture (22–36 MME Hazard Ratio (HR) = 1.35, 95% Confidence Interval (CI): 1.21–1.51; 37–50 MME HR = 1.38, 95% CI: 1.24–1.54; ⟩50 MME HR = 1.35, 95% CI: 1.20–1.52).ConclusionsWe observed an increased fracture risk in all three higher categories of opioid exposure relative to the lowest category (⟨22 MME). The risk of a fracture should be considered in opioid treatment decisions.