Elderly/Long-term Care

Use of the pain reliever propoxyphene is associated with a higher risk of hip fracture among the elderly

Propoxyphene, which is no more effective than acetaminophen for relieving pain, is widely prescribed for elderly patients, even though it is considered inappropriate for this group. Like other opioids, propoxyphene often causes dizziness and sedation, increasing the risk of falling. A new study found a two-fold higher risk of hip fracture among elderly patients using propoxyphene compared with patients not using analgesics. Sachin J. Kamal-Bahl, Ph.D., of the University of Maryland, Baltimore, and colleagues prospectively studied Medicare claims data from 1999 and 2000 for 362,503 elderly patients to identify propoxyphene users and nonusers in the 14 days before each hip fracture.

During a 15-month followup, about 10 percent of the sample had at least 1 propoxyphene prescription filled and about 1 percent sustained a hip fracture. Propoxyphene users had a two-fold higher risk for hip fracture compared with nonusers of analgesics. Following adjustment for multiple factors affecting hip fracture risk, elderly patients who used low-dose propoxyphene (260 mg or less) had a 26 percent greater risk of hip fracture, and those on the high dose (more than 260 mg) had double the risk. Other opioid analgesics also doubled the risk for hip fracture.

However, nonopioid analgesics, which provide better or similar efficacy for pain as propoxyphene, were not associated with higher fracture risk. Thus, patients with mild to moderate pain should receive an appropriate nonopioid analgesic rather than propoxyphene. On the other hand, patients being treated with propoxyphene for severe pain may be switched to more effective narcotic agents. However, the researchers note that clinicians should still weigh the risk of hip fracture with other narcotics against potential benefits when prescribing them to older adults. Their study was supported by the Agency for Healthcare Research and Quality (HS13551).

See "Propoxyphene use and risk for hip fractures in older adults," by Dr. Kamal-Bahl, Bruce C. Stuart, Ph.D., and Mark H. Beers, M.D., in the September 2006 American Journal of Geriatric Pharmacotherapy 4(3), pp. 219-220.

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