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Less NSAIDs for Arthritis Equals More Falls


 

EXPERT ANALYSIS FROM A SYMPOSIUM SPONSORED BY THE AMERICAN COLLEGE OF RHEUMATOLOGY

Thus, the use of narcotic analgesics as the sole prescription medication for pain relief in elderly OA patients more than doubled after Vioxx was withdrawn from the market. The patients on narcotic analgesics with or without a COX-2-selective NSAID had a fourfold greater rate of falls or fractures than those on nonselective NSAIDs or COX-2-selective agents.

Dr. Cronstein and his coworkers also conducted a nested case-control study of 3,830 elderly Geisinger OA patients with fractures and 11,490 others matched for age and Charlson Comorbidity Index without fractures. In a multivariate analysis, patients on narcotic analgesics had a threefold greater risk of falls or fractures than those on either COX-2-selective or nonselective NSAIDs.

Dr. Cronstein observed that large studies indicate that the frequency of positive tests for prescription narcotic analgesics in employees involved in workplace accidents has increased significantly since 2005. Meanwhile, prescription narcotic analgesic abuse among younger individuals has ballooned. But while it’s interesting to speculate that these trends might be related to Vioxx going off the market and the general disenchantment with all NSAIDs that followed, there is no concrete evidence of such an association, he conceded.

This work was funded by the National Institutes of Health, the Geisinger Clinic, and the Clinical and Translational Science Institute. Dr. Cronstein reported that he has served as a paid consultant to Allos, Bristol-Myers Squibb, CanFite Biopharmaceuticals, Cypress Laboratories, Gismo Therapeutics, Novartis, Protalex, Regeneron, and Savient. He has received research grants from the National Institutes of Health and numerous pharmaceutical companies.

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