Patterns of opioid use in the 12 months following geriatric fragility fractures: a population-based cohort study
Open accessAbstract
Objectives: Fractures of the hip, distal radius, and proximal humerus are common in the Medicare population. This study’s objective was to characterize patterns and duration of opioid use, including regional variations in use, after both surgical and non-operative management. Design: Population-based cohort study Setting and Participants: A cohort of opioid-naïve community-dwelling United States (US) Medicare beneficiaries who survived a hip, distal radius, or proximal humerus fracture between January 1st, 2007 and December 31st, 2010. Cohort members were required to be opioid-naïve for 4 months prior to fracture. Measures: We analyzed the proportion of patients with an active opioid prescription in each month following the index fracture, and report continued fills at 12 months post-fracture. We also compared opioid prescription use in fractures treated surgically and non-surgically and characterized state-level variation in opioid prescription use at three months post-fracture. Results: There were 91,749 patients included in the cohort. Hip fracture patients had the highest rate of opioid use at 12 months (6.4%), followed by proximal humerus (5.7%), and distal radius (3.7%). Patients who underwent surgical fixation of proximal humerus and wrist fractures had higher rates of opioid use in each of the first 12 postoperative months compared to those managed non-operatively. There was significant variation of opioid use at the state level, ranging from 7.6% to 18.2% of fracture patients filling opioid prescriptions 3 months after the index fracture. Conclusions/Implications: Opioid-naïve patients sustaining fragility fractures of the hip, proximal humerus or distal radius are at risk to remain on opioid medications 12 months after their index injury, and surgical management of proximal humerus and distal radius fractures increases opioid use in the 12 months after the index fracture. There is significant state-level variation in opiate consumption after index fracture in non-vertebral geriatric fragility fractures. Opportunity exists for targeted quality improvement efforts to reduce the variation in opioid use following common geriatric fragility fractures.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In a population-based cohort of opioid-naive community-dwelling US citizens, continuous opioid use was reported in 6.4% of patients one year after an index hip fracture.
“Similarly, a population-based cohort study of opioid-naive community-dwelling US citizens reported continuous opioid use in 6.4% of patients one year after sustaining an index hip fracture (233).”
From Exogenous Opioids and the Human Endocrine System: An Endocrine Society Scientific Statement (2024) · cites this paper as [233]
The Results (Opiate prescriptions after fracture; page unavailable) report that 6.4% of hip-fracture patients continued to fill opioid prescriptions at 12 months. The Abstract (Setting and Participants; page unavailable) identifies the cohort as opioid-naïve, community-dwelling US Medicare beneficiaries. The study measured prescription fills by month, not uninterrupted opioid use throughout the year, and describes beneficiaries rather than establishing citizenship. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Incidence and Economic Burden of Osteoporosis-Related Fractures in the United States, 2005–2025
Burge, R., Dawson-Hughes, B., Solomon, D. H., Wong, J. B., King, A., & Tosteson, A. (2007) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.061113 · Cited by 4,026 · see citing works
Self-citationOpioid Complications and Side Effects
Benyamin, R. M. (2008) · Pain Physician · doi:10.36076/ppj.2008/11/s105 · Cited by 2,271 · see citing works
Small Area Variations in Health Care Delivery
Wennberg, J. E., & Gittelsohn, A. M. (1973) · Science · doi:10.1126/science.182.4117.1102 · Cited by 1,891 · see citing works
Increases in drug and opioid overdose deaths — United States, 2000–2014
Rudd, R. A., Aleshire, N., Zibbell, J. E., & Gladden, R. M. (2016) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6450a3 · Cited by 1,859 · see citing works
Fisher, E. S., Wennberg, D. E., Stukel, T. A., Gottlieb, D. J., Lucas, F. L., & Pinder, É. L. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-4-200302180-00006 · Cited by 1,537 · see citing works
Fisher, E. S., Wennberg, D. E., Stukel, T. A., Gottlieb, D. J., Lucas, F. L., & Pinder, É. L. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-4-200302180-00007 · Cited by 1,341 · see citing works
Ray, N. F., Chan, J. K., Thamer, M., & Melton, L. J. (1997) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.1997.12.1.24 · Cited by 1,281 · see citing works
The unequal burden of pain: confronting racial and ethnic disparities in pain
Green, C. R., Anderson, K. O., Baker, T. A., Campbell, L. C., Decker, S., Fillingim, R. B., Kaloukalani, D. A., Lasch, K. E., Myers, C., Tait, R. C., et al. (2003) · Pain Medicine · doi:10.1046/j.1526-4637.2003.03034.x · Cited by 1,248 · see citing works
Rates and risk factors for prolonged opioid use after major surgery: population based cohort study
Clarke, H., Soneji, N. D. R., Ko, D. T., Yun, L., & Wijeysundera, D. N. (2014) · BMJ · doi:10.1136/bmj.g1251 · Cited by 941 · see citing works
A Flood of Opioids, a Rising Tide of Deaths
Okie, S. (2010) · New England Journal of Medicine · doi:10.1056/nejmp1011512 · Cited by 832 · see citing works
Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments
Pletcher, M. J., Kertesz, S. G., Kohn, M. A., & Gonzales, R. (2008) · JAMA · doi:10.1001/jama.2007.64 · Cited by 826 · see citing works
Characteristics of Opioid Prescriptions in 2009
Volkow, N. D. (2011) · JAMA · doi:10.1001/jama.2011.401 · Cited by 813 · see citing works
Morrison, R. S., Magaziner, J., Gilbert, M., Koval, K. J., McLaughlin, M. A., Orosz, G., Strauss, E., & Siu, A. L. (2003) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/58.1.m76 · Cited by 783 · see citing works
The crippling consequences of fractures and their impact on quality of life
Cooper, C. C. (1997) · The American Journal of Medicine · doi:10.1016/s0002-9343(97)90022-x · Cited by 696 · see citing works
Osteoporosis: impact on health and economics
Harvey, N. C., Dennison, E. M., & Cooper, C. C. (2010) · Nature Reviews Rheumatology · doi:10.1038/nrrheum.2009.260 · Cited by 690 · see citing works
Manchikanti, L. (2008) · Pain Physician · doi:10.36076/ppj.2008/11/s63 · Cited by 642 · see citing works
The impact of post-operative pain on outcomes following hip fracture
Morrison, S. R., Magaziner, J., McLaughlin, M. A., Orosz, G., Silberzweig, S. B., Koval, K. J., & Siu, A. L. (2003) · Pain · doi:10.1016/s0304-3959(02)00458-x · Cited by 616 · see citing works
Sex differences in pain perception
Wiesenfeld‐Hallin, Z. (2005) · Gender Medicine · doi:10.1016/s1550-8579(05)80042-7 · Cited by 606 · see citing works
Gibson, S. J., & Farrell, M. J. (2004) · Clinical Journal of Pain · doi:10.1097/00002508-200407000-00004 · Cited by 481 · see citing works
Trends in Abuse of OxyContin® and Other Opioid Analgesics in the United States: 2002-2004
Cicero, T. J., Inciardi, J. A., & Muñoz, Á. (2005) · Journal of Pain · doi:10.1016/j.jpain.2005.05.004 · Cited by 461 · see citing works
Sex differences in opioid analgesia: clinical and experimental findings
Fillingim, R. B., & Gear, R. W. (2004) · European Journal of Pain · doi:10.1016/j.ejpain.2004.01.007 · Cited by 301 · see citing works
Relationship of Opioid Use and Dosage Levels to Fractures in Older Chronic Pain Patients
Saunders, K. W., Dunn, K. M., Merrill, J. O., Sullivan, M. D., Weisner, C. M., Braden, J. B., Psaty, B. M., & Korff, M. V. (2010) · Journal of General Internal Medicine · doi:10.1007/s11606-009-1218-z · Cited by 271 · see citing works
Variation profiles of common surgical procedures
Birkmeyer, J. D., Sharp, S. M., Finlayson, S. R. G., et al. (1998) · Surgery · doi:10.1016/s0039-6060(98)70017-0 · Cited by 270 · see citing works
A Review of Potential Adverse Effects of Long-Term Opioid Therapy
Baldini, A., Korff, M. V., & Lin, E. H. B. (2012) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.11m01326 · Cited by 259 · see citing works
Defining Ethnic and Racial Differences in Osteoporosis and Fragility Fractures
Cauley, J. A. (2011) · Clinical Orthopaedics and Related Research · doi:10.1007/s11999-011-1863-5 · Cited by 247 · see citing works
Individual differences in pain responses
Fillingim, R. B. (2005) · Current Rheumatology Reports · doi:10.1007/s11926-005-0018-7 · Cited by 232 · see citing works
Fracture Risk in the U.S. Medicare Population
BARRETT, J. A., Baron, J. A., Karagas, M. R., & Beach, M. L. (1999) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(98)00167-x · Cited by 222 · see citing works
Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability
Meredith, P. J., Strong, J., & Feeney, J. A. (2006) · Pain · doi:10.1016/j.pain.2006.02.025 · Cited by 218 · see citing works
Sanders, K. M., Nicholson, G. C., Watts, J. J., Pasco, J. A., Henry, M. J., Kotowicz, M. A., & Seeman, E. (2006) · Bone · doi:10.1016/j.bone.2005.06.004 · Cited by 186 · see citing works
A Revised Clinician’s Guide to the Prevention and Treatment of Osteoporosis
Dawson‐Hughes, B. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0926 · Cited by 180 · see citing works
Jena, A. B., Goldman, D. P., Weaver, L., & Karaca‐Mandic, P. (2014) · BMJ · doi:10.1136/bmj.g1393 · Cited by 153 · see citing works
Zerzan, J. T., Morden, N. E., Soumerai, S. B., Ross‐Degnan, D., Roughead, E. E., Zhang, F., Simoni, J. M., & Sullivan, S. D. (2006) · Medical Care · doi:10.1097/01.mlr.0000228025.04535.25 · Cited by 148 · see citing works
Παπαϊωάννου, Α., Kennedy, C. C., Ioannidis, G., Gao, Y., Sawka, A. M., Goltzman, D., Tenenhouse, A., Pickard, L. E., Olszynski, W. P., Davison, K. S., et al. (2007) · Osteoporosis International · doi:10.1007/s00198-007-0483-0 · Cited by 146 · see citing works
Prescription Opioid Use Among Disabled Medicare Beneficiaries
Morden, N. E., Munson, J. C., Colla, C. H., Skinner, J., Bynum, J., Zhou, W., & Meara, E. R. (2014) · Medical Care · doi:10.1097/mlr.0000000000000183 · Cited by 138 · see citing works
Self-citationThe relationship of gender to pain
Vallerand, A. H., & Polomano, R. C. (2000) · Pain Management Nursing · doi:10.1053/jpmn.2000.9759 · Cited by 128 · see citing works
Lindenhovious, A. L. C., Helmerhorts, G. T. T., Schnellen, A. C., Vrahas, M. S., Ring, D., & Kloen, P. (2009) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0b013e31818c12ee · Cited by 125 · see citing works
Global Forum: Fractures in the Elderly
Court-Brown, C. M., & McQueen, M. M. (2016) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.15.00793 · Cited by 120 · see citing works
Frasco, P. E., Sprung, J., & Trentman, T. L. (2005) · Anesthesia and Analgesia · doi:10.1213/01.ane.0000139354.26208.1c · Cited by 111 · see citing works
Cone, E. J., Fant, R. V., Rohay, J. M., Caplan, Y. H., Ballina, M., Reder, R. F., Spyker, D., & Haddox, J. D. (2003) · Journal of Analytical Toxicology · doi:10.1093/jat/27.2.57 · Cited by 107 · see citing works
Fredheim, O. M. S., Skurtveit, S. O., Breivik, H., et al. (2009) · European Journal of Pain · doi:10.1016/j.ejpain.2009.05.006 · Cited by 92 · see citing works
Hospital Prescribing of Opioids to Medicare Beneficiaries
Jena, A. B., Goldman, D. P., & Karaca‐Mandic, P. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.2737 · Cited by 82 · see citing works
Patterns of Prescription Drug Use Before and After Fragility Fracture
Munson, J. C., Bynum, J., Bell, J., Cantu, R. V., McDonough, C. M., Wang, Q., Tosteson, T. D., & Tosteson, A. N. A. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.4814 · Cited by 78 · see citing works
Self-citationPatient perception of pain care in hospitals in the United States
Gupta, A. (2009) · Journal of Pain Research · doi:10.2147/jpr.s7903 · Cited by 73 · see citing works
The spectrum of fractures in the elderly
Court-Brown, C. M., Clement, N. D., Duckworth, A. D., et al. (2014) · The Bone & Joint Journal · doi:10.1302/0301-620x.96b3.33316 · Cited by 70 · see citing works
Second fractures among older adults in the year following hip, shoulder, or wrist fracture
Bynum, J., Bell, J., Cantu, R. V., et al. (2016) · Osteoporosis International · doi:10.1007/s00198-016-3542-6 · Cited by 67 · see citing works
Self-citationGenetic predictors of acute and chronic pain
Edwards, R. R. (2006) · Current Rheumatology Reports · doi:10.1007/s11926-006-0034-2 · Cited by 66 · see citing works
Häuser, W., Petzke, F. W., Radbruch, L., & Tölle, T. R. (2016) · Pain Management · doi:10.2217/pmt.16.5 · Cited by 62 · see citing works
Forecasting the burden of future postmenopausal hip fractures
Omsland, T. K., & Magnus, J. H. (2014) · Osteoporosis International · doi:10.1007/s00198-014-2781-7 · Cited by 49 · see citing works
Interstate Variation in the Burden of Fragility Fractures
King, A. B., Tosteson, A. N. A., Wong, J. B., Solomon, D. H., Burge, R. T., & Dawson‐Hughes, B. (2008) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.081226 · Cited by 27 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- [9]General OotS. Bone health and osteoporosis: a report of the Surgeon General. 2004. 20945569
Cited by
Sorted by citations
The effect of opiates on bone formation and bone healing
Coluzzi, F., Scerpa, M. S., & Centanni, M. (2020) · Current Osteoporosis Reports · doi:10.1007/s11914-020-00585-4 · Cited by 55 · see citing works
Exogenous Opioids and the Human Endocrine System: An Endocrine Society Scientific Statement
Karavitaki, N., Bettinger, J. J., Biermasz, N., Christ-Crain, M., Gadelha, M. R., Inder, W. J., Tsourdi, E., Wakeman, S. E., & Zatelli, M. (2024) · Endocrine Reviews · doi:10.1210/endrev/bnae023 · Cited by 14 · see citing works
- Authors
- Torchia, M. T., Munson, J., Tosteson, T. D., Tosteson, A. N. A., Wang, Q., McDonough, C. M., Morgan, T. S., Bynum, J. P. W., & Bell, J.-E.
- Affiliations
- Dartmouth–Hitchcock Medical Center (US)
- Dartmouth College (US)
- Dartmouth Institute for Health Policy and Clinical Practice (US)
- University of Pittsburgh (US)
- Corresponding author
- Bell, John-Erik
- ORCID
- Venue
- Journal of the American Medical Directors Association
- Publisher
- Elsevier BV
- Published
- 2019-03
- Volume
- 20
- Issue
- 3
- Pages
- 298-304
- ISSN
- 1525-8610 (ISSN-L)
- PMC
- PMC6400293
- OpenAlex
- W2916133962
- Semantic Scholar
- 81ac7345e33c032c56ec378315ee8b344715ac1f
- Cited by
- 21
- References
- 49
- Citations by year
- 2025: 4 · 2024: 5 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 3
- FWCI
- 2.07
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Medical Directors Association (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (P60AR062799)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- opioid use, fragility fractures, hip fracture, distal radius fracture, proximal humerus fracture, geriatric fractures, opioid prescription patterns, surgical fixation, conservative treatment, state-level variation, Medicare beneficiaries, opioid-naive patients, postoperative pain management
- MeSH terms
- Aged, Aged, 80 and over, Analgesics, Opioid, Drug Utilization, Female, Humans, Male, United States, Cohort Studies, Osteoporotic Fractures
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
