Study Examines Hip Fracture Risk and Opioid Use in Dementia Patients

Background on Pain in Dementia Patients

A recent study published in the journal Pain explored the relationship between the use of strong painkillers and the risk of hip fractures in individuals with dementia. Pain is prevalent among those suffering from Alzheimer’s and other forms of dementia, with approximately half of these patients experiencing chronic pain. Research indicates that the incidence of pain among dementia patients tends to increase with age. For those experiencing significant pain, strong painkillers, particularly opioid pain relievers, are often necessary. It is estimated that 28% of community-dwelling dementia patients utilize opioid medications.

Risks Associated with Opioid Use in Older Adults

Older adults are particularly vulnerable to the side effects of opioid painkillers due to age-related changes in drug metabolism and handling. This increased sensitivity raises the likelihood of adverse effects such as drowsiness and cognitive impairments, subsequently heightening the risk of falls and fractures.

Previous Findings on Dementia and Hip Fractures

While it is established that dementia patients face a greater risk of hip fractures, the specific impact of opioid use on this risk had not been previously investigated. To address this gap, researchers from Finland conducted a study to determine if there is an association between opioid use and hip fractures among community-living dementia patients.

Study Methodology

The researchers analyzed a cohort of 70,718 community-dwelling individuals diagnosed with Alzheimer’s dementia in Finland. Participants included those diagnosed between 2010 and 2011. The study excluded frequent opioid users, individuals with prolonged hospital stays, and those with a history of hip fractures. Opioid users were matched 1:1 with non-opioid users based on age, gender, and duration since their dementia diagnosis. The opioids were classified into categories: weak opioids (like codeine and tramadol), buprenorphine, and strong opioids (such as morphine, oxycodone, and hydromorphone). Only the first instance of hip fracture was considered in the analysis.

Findings of the Study

The study revealed that Alzheimer’s patients using opioids for pain management had an elevated risk of hip fractures. Additionally, the risk was found to increase with higher doses of opioids. Notably, the risk was most significant during the initial two months of opioid use but diminished and became statistically insignificant with prolonged use, suggesting that individuals may develop a tolerance to the side effects of opioids over time.

Implications and Future Research

The study’s findings are relevant due to the large population of Alzheimer’s patients examined, making the results applicable to similar demographics. The researchers effectively matched opioid and non-opioid users based on critical hip fracture risk factors and excluded frequent opioid users to mitigate biases related to tolerance. However, the study did not account for other lifestyle factors that could contribute to hip fracture risk.

In light of these results, the authors recommend further research to investigate whether initiating treatment with lower opioid doses and gradual dose increases may help mitigate the risk of hip fractures in Alzheimer’s patients.

References

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
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