title: Opioids contribute to fracture risk: a meta-analysis of 8 cohort studies.
abstract: OBJECTIVE
  To evaluate the association between chronic opioid use for non-cancer pain and fracture risk by conducting a meta-analysis of cohort studies.
  
  
  METHODS
  Cohort studies were identified by searching PubMed and EMBASE from their inception to July 2014. A fracture was considered an endpoint. The information was extracted by two authors independently. When the heterogeneity was significant, a random-effects model was used to calculate the overall pooled risk estimates.
  
  
  RESULTS
  Eight cohort studies were included in the final meta-analysis. On the basis of the Newcastle-Ottawa Scale (NOS), six studies were considered to be of high quality. The overall combined relative risk for the use of opioids and fractures was 1.88 (95% confidence interval [CI] 1.51-2.34). A subgroup analysis revealed the sources of heterogeneity. The sensitivity analysis indicated stable results, and no publication bias was observed.
  
  
  CONCLUSIONS
  This meta-analysis of cohort studies demonstrates that opioids significantly increase the risk of fractures.
authors.affiliation: Department of Orthopedic Surgery, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, China.
authors.forename: Zhaowei
authors.initials: Z
authors.lastname: Teng
authors.affiliation: Department of Nephrology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Anesthesiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, China.
authors.forename: Feihu
authors.initials: F
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, China.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Orthopedic Surgery, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, China.
authors.forename: Xiguang
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Orthopedic Surgery, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, China.
authors.forename: Chuanlin
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Orthopedic Surgery, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, China.
authors.forename: Shuangneng
authors.initials: S
authors.lastname: Wang
authors.affiliation: Trauma Center of Yunnan Province, The Second People's Hospital of Yunnan Province, Kunming, Yunan, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D015331:Cohort Studies; D050723:Fractures, Bone / Q000139:chemically induced*; D006801:Humans; D012306:Risk
chemical_list: D000701:Analgesics, Opioid