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Anticonvulsant and Opioid Use and Fractures in Veterans with Spinal Cord Injury

Carbone L, Chin A, Lee TA, Burns S, Svircev J, Hoening H, Akhigbe T, Weaver FM. Anticonvulsant and Opioid Use and Fractures in Veterans with Spinal Cord Injury. Poster session presented at: American Society for Bone and Mineral Research Annual Meeting; 2011 Sep 17; San Diego, CA.




Abstract:

Purpose: Anticonvulsant and opioid use are associated with an increased risk for fracture in the general population. However, whether this also is true for patients with Spinal Cord Injury (SCI) has not been determined. Methods: We utilized the Veterans Affairs Spinal Cord Disease Registry to identify all male Veterans with a traumatic SCI two years duration from 2002-2007. Incident lower extremity fractures over during this time period and anticonvulsant and opioid use within five years prior to the fracture were identified. The association of anticonvulsant use overall, by type (enzyme inducing, non-enzyme inducing or both), by number (monotherapy vs. polytherapy) and by individual medication was determined. The relationship of benzodiazepine (BZD) use with overall fracture risk was determined. The relationship of opioid use to lower extremity fracture risk was also analyzed. Results: There were 2964 anticonvulsant users and 4490 non users of these medications and 892 opioid users and 6562 non users of these medications. 892 Veterans developed an incident lower extremity fracture during this time period. After adjustment for covariates, there was no significant association between anticonvulsant use and lower extremity fractures (OR 0.96 (95% CI 0.82-1.11). There was no significant association between type (p = 0.79) or number of anticonvulsants (p = 0.22) used and incident fractures. BZD use was not associated with fracture risk (OR 1.04 (95% CI 0.89-1.22). Among individual anticonvulsants, topiramate (OR 1.93 (95%% CI 1.18-3.18) and temazepam (OR 1.44 (95% CI 1.12-1.85) were positively and gabapentin (OR 0.83 (95% CI 0.69-0.99) was negatively associated with fracture risk. After adjustment for covariates, there was no significant association between opioid use and lower extremity fractures (OR 1.01 (95% CI 0.86-1.17)). However, there was a significant positive association between hydromorphone (OR 1.91 (95% CI 1.12-3.26), meperidine (OR 1.83 (95% CI 1.04-3.24) and morphine use (OR 1.28 (95% CI 1.01-1.61) and risk for lower extremity fractures. Conclusions: The classes of anticonvulsant and opioid drugs are not associated with an increased risk for lower extremity fractures in males with SCI. However, the risk of fracture varies by individual anticonvulsant and opioid used. The selection of an anticonvulsant or an opioid for use in SCI patients at increased risk for fracture should be guided by the fracture risk associated with that particular drug.





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