Opioid Use, Physical Function, Falls, and Fracture in Older Men

描述(申请人提供)：老年人受肌肉骨骼疼痛状况的影响不成比例，比年轻人接受更多的阿片类止痛药，但阿片类药物治疗老年人持续性肌肉骨骼疼痛的益处和危害尚不清楚。本研究的目的是评估阿片类镇痛剂对患有持续性背部、髋部或膝部疼痛的老年男性跌倒、骨折和功能结果的潜在不良影响，并检查阿片类药物相关的风险是否因存在关键的老年风险因素(即基线功能障碍、认知障碍和体能低下)而不同。在一组患有持续性背部、髋部或膝部疼痛的老年男性中，这项研究旨在评估以下方面：1)阿片类止痛剂的使用与事件和复发跌倒的风险之间的关系；2)阿片类止痛剂的使用与临床骨折事件的风险之间的关系；以及3)阿片类止痛剂的使用与自我报告的身体功能和身体表现的客观指标下降之间的关系。这项研究将分析NIH资助的一项针对65岁及以上社区居住男性的前瞻性队列研究，即男性骨质疏松性骨折(MROS)研究中收集的现有纵向数据。MROS参与者在2000至2002年间完成了基线检查，并在大约4.5年和7年后完成了随后的两次检查。从参与者每次检查时携带的药物容器中记录当前药物、剂量和使用频率。每次检查的评估包括客观身体表现(包括力量、动态平衡和步速)、自我报告的身体功能(包括日常生活和身体任务的独立活动的限制)、认知功能和自我报告的身体活动。在两次访问之间，每四个月联系参与者一次，以确定是否发生新的跌倒或骨折。在这项研究中，分析队列包括在基线时大部分或所有时间报告背部、髋关节或膝盖疼痛的MROS参与者。报告使用阿片类止痛剂的参与者将与那些只使用非阿片类止痛药的参与者和那些报告没有使用止痛剂的参与者进行比较。倾向评分将被用来控制止痛药使用组之间的基线差异。将使用广义估计方程来模拟阿片类药物使用与事故坠落的主要后果之间的关系(目标1)。作为第二个衡量标准，反复跌倒的结果将使用Logistic回归进行评估。阿片类药物的使用与发生的临床骨折之间的关系将通过生存分析来建立首次骨折时间的模型(目标2)老年危险因素及其与止痛药类别的相互作用将作为附加协变量包括在后续模型中，以评估它们对阿片类药物与跌倒或骨折之间相关性的影响。将使用Logistic回归来模拟阿片类药物的使用与a)身体功能和b)身体表现下降之间的关系(目标3)。

DESCRIPTION (provided by applicant): Older adults are disproportionately affected by musculoskeletal pain conditions and receive more opioid analgesics than younger persons, but benefits and harms of opioid therapy for persistent musculoskeletal pain in older adults are unclear. The objectives of this study are to evaluate potential adverse effects of opioid analgesics on falls, fractures, and functional outcomes in older men with persistent back, hip, or knee pain and to examine whether opioid-associated risk varies according to the presence of key geriatric risk factors (i.e., baseline functional impairment, cognitive impairment, and poor physical performance). In a cohort of older men with persistent back, hip, or knee pain, the study aims to evaluate the following: 1) associations between opioid analgesic use and risk of incident and recurrent falls; 2) associations between opioid analgesic use and risk of incident clinical fractures; and 3) associations between opioid analgesic use and decline in self-reported physical function and objective measures of physical performance. This study will analyze existing longitudinal data collected in an NIH-funded prospective cohort study of community-dwelling men age 65 years and older, the Osteoporotic Fractures in Men (MrOS) study. MrOS participants completed a baseline examination between 2000 and 2002 and two subsequent examinations, approximately 4.5 years and 7 years later. Current medications, dose, and frequency of use were recorded from medication containers that participants brought to each examination. Assessments at each examination included measures of objective physical performance (including strength, dynamic balance, and gait speed), self-reported physical function (including limitations in independent activities of daily living and physical tasks), cognitive function, and self-reported physical activity. Participants were contacted every four months between visits to determine occurrence of new falls or fractures. For this study, the analytic cohort includes MrOS participants who reported back, hip, or knee pain most or all of the time at baseline. Participants who reported opioid analgesic use will be compared with those who used only non-opioid analgesics and those who reported no analgesic use. Propensity scores will be used to control for baseline differences between analgesic use groups. Generalized estimating equations will be used to model the relationship between opioid use and the primary outcome of incident falls (aim 1). As a secondary measure, the outcome of recurrent falls will be evaluated using logistic regression. Associations between opioid use and incident clinical fractures will be examined using survival analysis to model time to first fracture (aim 2) Geriatric risk factors and their interactions with analgesic category will be included as additiona covariates in subsequent models to evaluate their effects on associations between opioids and falls or fractures. Logistic regression will be used to model the relationship between opioid use and decline in a) physical function and b) physical performance (aim 3).