ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2012
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).
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 5 of them syntheses that pooled it.
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Who cites it
47 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Investigating the causal relationship between ankylosing spondylitis and osteoporosis in the European population: a bidirectional Mendelian randomization study.Frontiers in immunology · 2023Pooled it
- Aspirin and fracture risk: a systematic review and exploratory meta-analysis of observational studies.BMJ open · 2020Pooled it
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- Nonsteroidal anti-inflammatory drugs, gastroprotection, and benefit-risk.Pain practice : the official journal of World Institute of Pain · 2014Pooled it
- Potential Adverse Effect of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) on Bisphosphonate Efficacy: An Exploratory Post Hoc Analysis From a Randomized Controlled Trial of Clodronate.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2022Trial
- Efficacy and Safety of Different Aceclofenac Treatments for Chronic Lower Back Pain: Prospective, Randomized, Single Center, Open-Label Clinical Trials.Yonsei medical journal · 2017Trial
- A randomised controlled trial of low-dose aspirin for the prevention of fractures in healthy older people: protocol for the ASPREE-Fracture substudy.Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention · 2016Trial
- Psychotropic medication use and bone fracture risk among patients with multiple sclerosis: a real-world study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Regular Proton-Pump Inhibitor Intake is Associated with Deterioration of Peripheral Bone Mineral Density, Microarchitecture, and Strength in Older Patients as Assessed by High-Resolution Peripheral Quantitative Computed Tomography (HR-pQCT).Calcified tissue international · 2025Article
- Application of Mendelian randomization analysis to explore causal associations of aspirin use with bone mineral density and risk of fracture.Hereditas · 2025Article
- Anti-Osteoporosis Is Imperative in Prevention of Progress of Ankylosing Spondylitis.International journal of general medicine · 2025Article
- Clinical Features Associated With Rate of Fractures in Patients With Systemic Sclerosis: A US Cohort Study.Arthritis care & research · 2023Article
- Does chronic low-dose aspirin use benefit bone health? A cross-sectional study on patients with type 2 diabetes mellitus.BMC endocrine disorders · 2023Article
- NHANES cross sectional study of aspirin and fractures in the elderly.Scientific reports · 2023Observational
- Sustained Morphine Delivery Suppresses Bone Formation and Alters Metabolic and Circulating miRNA Profiles in Male C57BL/6J Mice.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2022Article
- Article
- Association between osteoporosis or osteopenia and taking antiplatelet agents in general US population of NHANES.Frontiers in endocrinology · 2022Article
- Association between circulating 25-hydroxyvitamin D concentrations and hip replacement for osteoarthritis: a prospective cohort study.BMC musculoskeletal disorders · 2021Article
- A Literature Review of the Potential Impact of Medication on Vitamin D Status.Risk management and healthcare policy · 2021Review
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
unlabelledPain 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.
introductionTo 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.
methodsTwo-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).
resultsParacetamol 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.
conclusionSignificant 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.
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