OBJECTIVES : Opioids are associated with negative outcomes, including increased risk of falls and fractures. The objective of this study was to assess the frequency and risk factors associated with a fall or fracture among patients with osteoarthritis (OA) of the hip and/or knee.

METHODS : The Optum Healthcare Solutions, Inc. data (1/2012-3/2017) were used to identify adult patients (≥18) with ≥2 diagnoses of hip and/or knee OA, ≥90 days supply of opioids during a three-year period. The index date was defined as the date of their first opioid prescription after the first OA diagnosis. Patients with cancer diagnosis(es) were excluded. Demographic, treatment, and clinical characteristics associated with falls/fractures were assessed using logistic regression.

RESULTS : 3,886 of 16,663 (23%) patients meeting the inclusion criteria had ≥1 fall or fracture during the follow-up period. Of these 3,886 patients, 1,349 (35%) had ≥1 fall with an average of 3 fall claims, and 3,299 (85%) patients had ≥1 fracture with an average of 8 fracture claims during the follow-up. Spine fractures were most common (15.8%), followed by hip (12.5%). 27% of patients had ≥1 fracture associated with hospitalization. Median time to fall and fracture were 18.6, and 13.9 months, respectively. 57% of fall/fracture patients had an opioid prescription in the 30 days prior to the event. The most common type of opioid during this period were non-tramadol IR opioids with 44% of fall/fracture patients having ≥1 prescription. Significant (P<0.05) risk factors associated with ≥1 fall or fracture during the follow-up period included alcohol use (OR: 3.41), history of falling (OR: 2.19), use of non-tramadol opioids (OR: 1.31), age (OR: 1.03), benzodiazepine use (OR: 1.21), and diagnosis(es) of osteoporosis (OR: 2.06).

CONCLUSIONS : These findings suggest that risks of falls/fractures need to be considered when managing OA pain with opioids. The results point to the burden of these events.