ArticleJournal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research2020
Association of Tramadol Use With Risk of Hip Fracture.
Article in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed, 34 citations in OpenAlex.
- REACT (Real-world Emulated Clinical Trials): A Framework for Drug Repurposing Applied to Osteoporotic Fractures.medRxiv : the preprint server for health sciences · 2026Article
- REACT (Real-world Emulated Clinical Trials): A Framework for Drug Repurposing Applied to Osteoporotic Fractures.AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science · 2026Article
- An update on drug-drug interactions in older adults living with human immunodeficiency virus (HIV).Expert review of clinical pharmacology · 2024Review
- Unveiling unique clinical phenotypes of hip fracture patients and the temporal association with cardiovascular events.Nature communications · 2024Article
- Comparative safety of tramadol and other opioids following total hip and knee arthroplasty.BMC geriatrics · 2024Article
- Tramadol May Increase Risk of Hip Fracture in Older Adults with Post-Traumatic Osteoarthritis.Journal of personalized medicine · 2023Article
- Recent advances in the identification of related factors and preventive strategies of hip fracture.Frontiers in public health · 2023Review
- Hip Fracture Risk After Treatment with Tramadol or Codeine: An Observational Study.Drug safety · 2022Observational
- Tramadol Versus Codeine in Hand Surgery.Cureus · 2022Article
- Multimechanistic Single-Entity Combinations for Chronic Pain Control: A Narrative Review.Cureus · 2022Review
- Medication use quality and safety in older adults: 2020 update.Journal of the American Geriatrics Society · 2022Review
- Article
- Perioperative Pain Management and Opioid Stewardship: A Practical Guide.Healthcare (Basel, Switzerland) · 2021Review
- Increasing Trends in Opioid Use From 2010 to 2018 in the Region of Valencia, Spain: A Real-World, Population-Based Study.Frontiers in pharmacology · 2020Article
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Authors and funding
10 authors at 5 institutions in 4 countries.
Funding
Abstract
Several professional organizations have recommended tramadol as one of the first-line or second-line therapies for patients with chronic noncancer pain and its prescription has been increasing rapidly worldwide; however, the safety profile of tramadol, such as risk of fracture, remains unclear. This study aimed to examine the association of tramadol with risk of hip fracture. Among individuals age 50 years or older without a history of hip fracture, cancer, or opioid use disorder in The Health Improvement Network (THIN) database in the United Kingdom general practice (2000-2017), five sequential propensity score-matched cohort studies were assembled, ie, participants who initiated tramadol or those who initiated one of the following medications: codeine (n = 146,956) (another commonly used weak opioid), naproxen (n = 115,109) or ibuprofen (n = 107,438) (commonly used nonselective nonsteroidal anti-inflammatory drugs [NSAIDs]), celecoxib (n = 43,130), or etoricoxib (n = 27,689) (cyclooxygenase-2 inhibitors). The outcome was incident hip fracture over 1 year. After propensity-score matching, the included participants had a mean age of 65.7 years and 56.9% were women. During the 1-year follow-up, 518 hip fracture (3.7/1000 person-years) occurred in the tramadol cohort and 401 (2.9/1000 person-years) occurred in the codeine cohort. Compared with codeine, hazard ratio (HR) of hip fracture for tramadol was 1.28 (95% confidence interval [CI] 1.13 to 1.46). Risk of hip fracture was also higher in the tramadol cohort than in the naproxen (2.9/1000 person-years for tramadol, 1.7/1000 person-years for naproxen; HR = 1.69, 95% CI 1.41 to 2.03), ibuprofen (3.4/1000 person-years for tramadol, 2.0/1000 person-years for ibuprofen; HR = 1.65, 95% CI 1.39 to 1.96), celecoxib (3.4/1000 person-years for tramadol, 1.8/1000 person-years for celecoxib; HR = 1.85, 95% CI 1.40 to 2.44), or etoricoxib (2.9/1000 person-years for tramadol, 1.5/1000 person-years for etoricoxib; HR = 1.96, 95% CI 1.34 to 2.87) cohort. In this population-based cohort study, the initiation of tramadol was associated with a higher risk of hip fracture than initiation of codeine and commonly used NSAIDs, suggesting a need to revisit several guidelines on tramadol use in clinical practice. © 2020 American Society for Bone and Mineral Research.
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