Rheumatology · General Practice · 2 h ago
Tramadol Linked to Lower Mortality and Fracture Risks Than Some Opioids in Osteoarthritis
A retrospective cohort study of more than 1 million adults aged 50 years or older with osteoarthritis compared outcomes after initiating tramadol, codeine, hydrocodone, or oxycodone. Tramadol use was associated with lower mortality and fracture risks than hydrocodone or oxycodone, but the observational findings do not establish that tramadol caused these differences.
- Cohort included 1,057,635 adults with osteoarthritis.
- Tramadol had similar mortality risk to codeine.
- Mortality and fracture risks were lower than with hydrocodone or oxycodone.
- Observational results do not establish causation.
Researchers used Optum Clinformatics Data Mart claims from 2005–2021 to conduct a retrospective cohort study of adults aged 50 years or older with osteoarthritis who initiated an opioid. The 1,057,635 participants had a mean age of 69.1 years, and 62.5% were female. After propensity score weighting, the investigators used weighted Cox models to compare all-cause mortality and fractures among initiators of tramadol, codeine, hydrocodone, and oxycodone.
During follow-up, 9,988 deaths and 10,455 fractures occurred. Tramadol was associated with similar mortality risk to codeine (hazard ratio [HR] 0.93, 95% CI 0.73–1.19), but lower risk than hydrocodone (HR 0.81, 95% CI 0.70–0.93) and oxycodone (HR 0.40, 95% CI 0.34–0.47). Fracture risk was also similar to codeine (HR 1.10, 95% CI 0.96–1.25) and lower than hydrocodone (HR 0.91, 95% CI 0.83–0.98) and oxycodone (HR 0.83, 95% CI 0.75–0.93).
The findings may inform comparisons when opioid therapy is being considered for osteoarthritis, but they do not show that tramadol itself reduces these risks. Residual confounding and uncertainty about longer-term comparative safety limit interpretation; the study does not establish a change in prescribing practice.
In practice
For adults aged 50 years or older with osteoarthritis who initiate opioid therapy, this claims-based cohort found tramadol associated with lower mortality and fracture risks than hydrocodone or oxycodone, and risks similar to codeine. These findings may inform comparative risk discussions, but they do not establish that tramadol causes better outcomes or that clinicians should change prescribing. Propensity weighting cannot eliminate residual confounding, and the authors note uncertainty about longer-term comparative safety.
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Arthritis & Rheumatology: Comparative risks of mortality and fractures in patients with osteoarthritis initiating tramadol versus other opioids ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.