Citation

Lo-Ciganic WH, Floden L L, Lee JK, Ashbeck EL, Zhou L, Chinthammit C, Purdy AW, Kwoh CK. Osteoarthritis Cartilage 2017; 25(9): 1390-1398.

Affiliation

University of Arizona Arthritis Center, College of Medicine, University of Arizona, Tucson, Arizona, USA; Department of Medicine, Division of Rheumatology, University of Arizona, Tucson, Arizona, USA. Electronic address: ckwoh@arthritis.arizona.edu.

Copyright

(Copyright © 2017, Osteoarthritis Research Society International, Publisher Elsevier Publishing)

DOI

10.1016/j.joca.2017.03.017

PMID

28385483

Abstract

OBJECTIVE: Few studies have compared the risk of recurrent falls across different types of analgesic use, and were limited to adjust for potential confounders (e.g., pain/depression severity). We aimed to assess analgesic use and the subsequent risk of recurrent falls, among participants with or at risk of knee osteoarthritis (OA).

METHODS: A longitudinal analysis included 4,231 participants aged 45-79 years at baseline with 4-year follow-up from the Osteoarthritis Initiative (OAI) cohort study. We grouped participants into six mutually exclusive subgroups based on annually assessed analgesic use in the following hierarchical order of analgesic/central nervous system potency: use of (1)opioids, (2)antidepressants, (3)other prescription pain medications, (4)over-the-counter pain medications, (5)nutraceuticals, and (6)no analgesics. We used multivariable modified Poisson regression models with a robust error variance to estimate the effect of analgesic use on the risk of recurrent falls(≥2) in the following year, adjusted for demographics and health status/behavior factors.

RESULTS: Opioid use increased from 2.7% at baseline to 3.6% at the 36-month visit (>80% using other analgesics/nutraceuticals), while other prescription pain medication use decreased from 16.7% to 11.9% over this time period. Approximately 15% of participants reported recurrent falls. Compared to those not using analgesics, participants used opioids and/or antidepressants had a 22-25% increased risk of recurrent falls (opioids: RRadjusted=1.22, 95%CI=1.04-1.45; antidepressants: RRadjusted=1.25, 95%CI=1.10-1.41).

CONCLUSION: Participants with or at risk of knee OA who were on opioids and antidepressants with/without other analgesics/nutraceuticals may have an increased risk of recurrent falls after adjusting for potential confounders. Use of opioids and antidepressants warrants caution.

Published by Elsevier Ltd.

Language: en

Keywords

analgesics; antidepressants; falls; knee osteoarthritis; non-steroidal anti-inflammatory drugs; opioids