title: Greater number of narcotic analgesic prescriptions for osteoarthritis is associated with falls and fractures in elderly adults.
abstract: OBJECTIVE
  To evaluate the changes in types of medications prescribed for pain before and after withdrawal of certain selective cyclooxygenase 2 (COX-2) inhibitors in 2004 and to determine whether there was an association with fall events in elderly adults with a diagnosis of osteoarthritis (OA).
  
  
  METHODS
  A nested case-control design using electronic medical records compiled between 2001 and 2009.
  
  
  METHODS
  Electronic medical records for care provided in an integrated health system in rural Pennsylvania over a 9-year period (2001-09), the midpoint of which rofecoxib and valdecoxib were pulled from the market.
  
  
  METHODS
  Thirteen thousand three hundred fifty-four individuals aged 65 to 89 with a diagnosis of OA.
  
  
  METHODS
  The incidence of falls and fractures was examined in relation to analgesics prescribed: narcotics, COX-2 inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs). The comparison sample of individuals who did not fall was matched 3:1 with those who fell according to age, sex, and comorbidity.
  
  
  RESULTS
  Narcotic analgesic prescriptions were associated with a significantly greater risk of falls and fractures. The likelihood of experiencing a fall/fracture was higher in participants prescribed narcotic analgesics than those prescribed a COX-2 inhibitor (odds ratio (OR) = 3.3, 95% confidence interval (CI) = 2.5-4.3) or NSAID (OR = 4.1, 95% CI = 3.7-4.5).
  
  
  CONCLUSIONS
  Use of narcotic analgesics is associated with risk of falls and fractures in elderly adults with OA, an observation that suggests that the current guidelines for the treatment of pain, which include first-line prescription of narcotics, should be reevaluated.
authors: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA. lrolita@montefiore.rog
authors: Lydia
authors: L
authors: Rolita
authors: Adele
authors: A
authors: Spegman
authors: Xiaoqin
authors: X
authors: Tang
authors: Bruce N
authors: BN
authors: Cronstein
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D016022:Case-Control Studies; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects; D004363:Drug Utilization; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D010003:Osteoarthritis / Q000188:drug therapy* / Q000453:epidemiology*; D010414:Pennsylvania; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors