In older patients, use of tramadol is associated with a higher risk of hip fracture than codeine and other common non-steroidal anti-inflammatory drugs, claims a UK database analysis.

The study included people aged 50 and older with no history of hip fracture, cancer or opioid use disorder in the UK’s Health Improvement Network database from 2000 to 2017.

Researchers assembled five sequential propensity score-matched cohort studies to compare participants who initiated tramadol or those who started one of five other common medications.

In the study, 147,000 were started on codeine; 115,000 on naproxen; 107,000 on ibuprofen; 43,000 on celecoxib; and 28,000 on etoricoxib, as reported in the Journal of Bone and Mineral Research. After propensity score matching, participants had a mean age of 66 and 57% were women.