Effects of analgesics on bone mineral density: a longitudinal analysis of the prospective SWAN cohort with three-group matching weights
Open accessAbstract
Purpose: To examine the effects of analgesics on bone mineral density (BMD), which have not been examined in a longitudinal study with multiple measurements. Methods: We investigated changes in BMD associated with new use of analgesics in a prospective longitudinal cohort of mid‐life women. BMD and medication use were measured annually. We compared BMD among new users of acetaminophen, NSAIDs, and opioids. Adjustment for baseline covariates was conducted through propensity score matching weights. On‐treatment analysis was conducted with inverse probability of censoring weights. Analysis based on the initial treatment group was also conducted to provide insights into selection bias. Repeated BMD measurements were examined with generalized estimating equations. Results: We identified 71 acetaminophen new users, 659 NSAID new users, and 84 opioid new users among 2365 participants. In the on‐treatment analysis, the opioid group in comparison to the acetaminophen group had an additional average BMD decline of −0.06% [−1.24, 1.11] per year in the spine and −0.45% [−1.51, 0.61] per year in the femoral neck. BMD mean trajectories over time suggested a fifth‐year decline in the opioid persistent users compared with other 2 groups. In the initial treatment group analysis, all 3 groups showed similar trajectories. Conclusion: The BMD decline over time was similar among the 3 groups. However, 5 years of continuous opioid use may be associated with a greater BMD decline than 5 years on other analgesics. Further studies examining the relationship between very long‐term persistent opioid use and BMD are warranted.
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In a prospective longitudinal nationwide study of mid-life women, opioid users had a more pronounced BMD decline over 5 years compared with users of acetaminophen and NSAIDs.
“A prospective longitudinal nationwide study of mid-life women assessed the impact of different analgesics (acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids] on bone mass and reported a more pronounced BMD decline over 5 years in opioid users (237).”
From Exogenous Opioids and the Human Endocrine System: An Endocrine Society Scientific Statement (2024) · cites this paper as [237]
The Methods describe a prospective cohort of mid-life women recruited at eight U.S. sites. The Results and Discussion say the on-treatment analysis suggested greater BMD decline in opioid users after five years of continuous use, but the group differences were not statistically significant; the initial-treatment-group analysis showed similar trajectories. The claim overstates this tentative finding as an observed greater decline in opioid users generally. (LLM, conf=0.90)
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- Authors
- Yoshida, K., Yu, Z., Greendale, G. A., Ruppert, K., Lian, Y., Tedeschi, S. K., Lin, T., Haneuse, S., Glynn, R. J., Hernández‐Díaz, S., & Solomon, D. H.
- Affiliations
- Brigham and Women's Hospital (US)
- University of California, Los Angeles (US)
- University of Pittsburgh (US)
- Harvard University (US)
- Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA USA
- Corresponding author
- Yoshida, Kazuki
- ORCID
- Venue
- Pharmacoepidemiology and Drug Safety
- Publisher
- Wiley
- Published
- 2017-12-12
- Volume
- 27
- Issue
- 2
- Pages
- 182-190
- ISSN
- 1053-8569 (ISSN-L)
- 1099-1557
- PMC
- PMC5799005
- OpenAlex
- W2772513731
- Semantic Scholar
- 881ef1257727192ea2edf2e49f951d6989bb308c
- Cited by
- 18
- References
- 50
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 4 · 2022: 1 · 2020: 6 · 2019: 1 · 2018: 3
- FWCI
- 3.01
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Pharmacoepidemiology and Drug Safety (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- United States National Institute on Aging
- National Institute of Nursing Research (NINR) and the National Institute of Health Office of Research on Women's Health (U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- analgesics, bone mineral density, osteoporosis, opioids, paracetamol, nonsteroidal anti-inflammatory drugs, middle-aged women, bone loss, persistent opioid use
- MeSH terms
- Analgesics, Opioid, Body Weight, Female, Femur Neck, Humans, Longitudinal Studies, Lumbar Vertebrae, Middle Aged, Pain, Prospective Studies, Quality of Life, Time Factors, Bone Density, Body Mass Index, Analgesics, Non-Narcotic, Osteoporotic Fractures
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