NSAID use may increase fracture risk in older women
MedWire News: Perimenopausal women who use non-steroidal anti-inflammatory drugs (NSAIDs) are more likely to experience a fracture than non-users, results of a 10-year Danish study show.
Pain medications such as paracetamol, NSAIDs, acetylsalicylic acid (ASA), and opioids are widely used, but there are doubts about their skeletal safety, note Peter Vestergaard (Aarhus University Hospital) and colleagues.
The researchers therefore investigated the effects of these pain medications on bone mineral density (BMD) and fracture risk in 2016 perimenopausal (and subsequently postmenopausal) women.
They measured BMD at baseline and after 10 years by dual-energy X-ray absorptiometry and collected detailed information on use of any of the drugs (both prescription and over the counter) at baseline and during follow-up; at 6 months, 1, 2, 5, and 10 years. Women were classed as "users" of the medication if they were exposed to it at some point before baseline or during follow-up.
The researchers report that paracetamol and NSAID users were significantly heavier than non-users, at 70.4 versus 67.7 kg and 71.6 versus 67.8 kg, respectively.
Compared with non-users, ASA users had significantly lower levels of 25-hydroxy-vitamin D (25OHD; 21.9 vs 25.3ng/ml), while opioid users had lower 25OHD (21.4 vs 25.2 ng/ml) and lower intakes of vitamin D (2.2 vs 3.1 μg/day).
Despite these differences, there were no differences in BMD at the spine, hip, forearm, or whole body at baseline between users and non-users, with the exception of higher BMD at the spine in NSAID-exposed versus non-exposed participants.
Over 10 years, the rate of BMD change did not differ significantly between users and non-users but there was a trend towards a higher BMD gain in the spine of women who reported paracetamol, NSAID, and opioid use compared with non-users.
During the follow-up period, 270 participants participants sustained a fracture. Women exposed to NSAIDs had a 44% higher risk for fracture than those not exposed, even after adjustment for potential confounders such as age, fracture history, and smoking status.
There was a trend towards more fractures with paracetamol and opioid use, but not with ASA use.
"Despite an absence of an effect over time on BMD, users of NSAID experienced more fractures than expected," write Vestergaard and co-authors in the journal Osteoporosis International.
"Further studies should address the effects of duration of use and dose, as well as the effects of continuous versus intermittent use of pain medication," they conclude.
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By Laura Dean