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Pain-relief medication and risk of fractures.

Medications to treat pain are in widespread use and any change in the risk of fracture may consequently have a significant impact at a population level. Strong analgesics of the opiate and opiate-like group are associated with an increased risk of fractures probably from an increased risk of falls resulting from the dizziness induced by these drugs. However, not all strong analgesics are associated with an increased risk of fractures. The differences are not readily explained from variations in pharmacokinetic properties. Weak analgesics mainly interact with the prostaglandin system; these drugs include non-steroidal anti-inflammatory drugs (NSAIDs), acetylsalicylic acid and acetaminophen. Acetaminophen is associated with an increased risk of fractures while acetylsalicylic acid is not. Some but not all NSAIDs are associated with an increased fracture risk, and the differences are not explained by variations in pharmacokinetic properties. More research is needed to determine if some analgesics are safer than others with respect to fracture risk.