ArticleAmerican journal of epidemiology2021
Opioids and the Risk of Fracture: A Self-Controlled Case Series Study in the Clinical Practice Research Datalink.
Article in American journal of epidemiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- "We adjusted for race": now what? A systematic review of utilization and reporting of race in American Journal of Epidemiology and Epidemiology, 2020-2021.Epidemiologic reviews · 2023Pooled it
- 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
- Pharmacoepidemiology unpacked: a roadmap for junior researchers.Frontiers in pharmacology · 2026Review
- Psychiatric, Cardiovascular and Skeletal Risks of Codeine versus Oxycodone in Hip Osteoarthritis: A Population-Based Cohort Study.Drug design, development and therapy · 2026Article
- Exploring Fall-Related Fracture Risk by Possible Fall-Risk Increasing Drugs in Japanese Older Adults Using Municipal Linked Medical and Long-Term Care Claim Data: A Nested Case-Control and Case-Crossover Study.Geriatrics & gerontology international · 2025Article
- Comparison of Management and Outcomes of Hip Fractures Among Low- and High-Income Patients in Six High-Income Countries.Journal of general internal medicine · 2025Article
- Opioid Use After Hip Fracture and Subsequent Fracture Outcomes: A Self-Controlled Case Series Design.Pharmacoepidemiology and drug safety · 2025Article
- Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Self-controlled study designs can be used to assess the association between exposures and acute outcomes while controlling for important confounders. Using routinely collected health data, a self-controlled case series design was used to investigate the association between opioid use and bone fractures in 2008-2017 among adults registered in the United Kingdom Clinical Practice Research Datalink. The relative incidence of fracture was estimated, comparing periods when these adults were exposed and unexposed to opioids, adjusted for time-varying confounders. Of 539,369 people prescribed opioids, 67,622 sustained fractures and were included in this study. The risk of fracture was significantly increased when the patient was exposed to opioids, with an adjusted incidence rate ratio of 3.93 (95% confidence interval (CI): 3.82, 4.04). Fracture risk was greatest in the first week of starting opioid use (adjusted incidence rate ratio: 7.81, 95% CI: 7.40, 8.25) and declined with increasing duration of use. Restarting opioid use after a gap in exposure significantly increased fracture risk (adjusted incidence rate ratio: 5.05, 95% CI: 4.83, 5.29) when compared with nonuse. These findings highlight the importance of raising awareness of fractures among patients at opioid initiation and demonstrate the utility of self-controlled methods for pharmacoepidemiologic research.
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