Analgesic use and risk of recurrent falls in participants with or at risk of knee osteoarthritis: data from the Osteoarthritis Initiative. Issue 9 (September 2017)

• Record Type: Journal Article
• Authors: Lo-Ciganic, W.-H.; Floden, L.; Lee, J.K.; Ashbeck, E.L.; Zhou, L.; Chinthammit, C.; Purdy, A.W.; Kwoh, C.K.
• Is Part Of: Osteoarthritis and cartilage. Volume 25:Issue 9(2017)
• Page Start: 1390
• Page End: 1398
• Publication Date: 2017-09
• Subjects: Analgesics -- Opioids -- Antidepressants -- Non-steroidal anti-inflammatory drugs -- Falls -- Knee osteoarthritis; Osteoarthritis -- Periodicals; Cartilage -- Periodicals; Osteoarthritis -- Periodicals; Cartilage -- Periodicals; Arthrose -- Périodiques; Articulations -- Maladies -- Périodiques; 616.7223005
• DOI: 10.1016/j.joca.2017.03.017
• Languages: English
• ISSNs: 1063-4584

Abstract

Summary: Objective: Few studies have compared the risk of recurrent falls across different types of analgesic use, and with limited adjustment for potential confounders (e.g., pain/depression severity). We assessed analgesic use and the subsequent risk of recurrent falls, among participants with or at risk of knee osteoarthritis (OA). Methods: A longitudinal analysis included 4231 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 (CNS) potency: use of (1) opioids, (2) antidepressants, (3) other prescription pain medications, (4) over-the-counter (OTC) 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 who 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 used 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.