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This study aimed to examine the association of tramadol with risk of hip fracture. Among individuals age 50\u2009years or older without a history of hip fracture, cancer, or opioid use disorder in The Health Improvement Network (THIN) database in the United Kingdom general practice (2000\u20132017), five sequential propensity score\u2013matched cohort studies were assembled, ie, participants who initiated tramadol or those who initiated one of the following medications: codeine (n = 146,956) (another commonly used weak opioid), naproxen (n = 115,109) or ibuprofen (n = 107,438) (commonly used nonselective nonsteroidal anti-inflammatory drugs [NSAIDs]), celecoxib (n = 43,130), or etoricoxib (n = 27,689) (cyclooxygenase-2 inhibitors). The outcome was incident hip fracture over 1 year. After propensity-score matching, the included participants had a mean age of 65.7\u2009years and 56.9% were women. During the 1-year follow-up, 518 hip fracture (3.7\/1000 person-years) occurred in the tramadol cohort and 401 (2.9\/1000 person-years) occurred in the codeine cohort. Compared with codeine, hazard ratio (HR) of hip fracture for tramadol was 1.28 (95% confidence interval [CI] 1.13 to 1.46). Risk of hip fracture was also higher in the tramadol cohort than in the naproxen (2.9\/1000 person-years for tramadol, 1.7\/1000 person-years for naproxen; HR = 1.69, 95% CI 1.41 to 2.03), ibuprofen (3.4\/1000 person-years for tramadol, 2.0\/1000 person-years for ibuprofen; HR = 1.65, 95% CI 1.39 to 1.96), celecoxib (3.4\/1000 person-years for tramadol, 1.8\/1000 person-years for celecoxib; HR = 1.85, 95% CI 1.40 to 2.44), or etoricoxib (2.9\/1000 person-years for tramadol, 1.5\/1000 person-years for etoricoxib; HR = 1.96, 95% CI 1.34 to 2.87) cohort. In this population-based cohort study, the initiation of tramadol was associated with a higher risk of hip fracture than initiation of codeine and commonly used NSAIDs, suggesting a need to revisit several guidelines on tramadol use in clinical practice. \u00a9 2020 American Society for Bone and Mineral Research.<\/jats:p>","DOI":"10.1002\/jbmr.3935","type":"journal-article","created":{"date-parts":[[2020,2,5]],"date-time":"2020-02-05T03:02:21Z","timestamp":1580871741000},"page":"631-640","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Association of Tramadol Use With Risk of Hip Fracture"],"prefix":"10.1093","volume":"35","author":[{"given":"Jie","family":"Wei","sequence":"first","affiliation":[{"name":"The Mongan Institute, Massachusetts General Hospital, Harvard Medical School Boston MA USA"},{"name":"Division of Rheumatology, Allergy, and Immunology, Department of Medicine Massachusetts General Hospital, Harvard Medical School Boston MA USA"},{"name":"Health Management Center Xiangya Hospital, Central South University Changsha China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy E","family":"Lane","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Health and Department of Medicine University of California School of Medicine Sacramento CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcy B","family":"Bolster","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Allergy, and Immunology, Department of Medicine Massachusetts General Hospital, Harvard Medical School Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maureen","family":"Dubreuil","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System Boston MA USA"},{"name":"Boston University School of Medicine Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Xiangya Hospital, Central South University Changsha China"},{"name":"The Mongan Institute, Massachusetts General Hospital, Harvard Medical School Boston MA USA"},{"name":"Division of Rheumatology, Allergy, and Immunology, Department of Medicine Massachusetts General Hospital, Harvard Medical School Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Devyani","family":"Misra","sequence":"additional","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Na","family":"Lu","sequence":"additional","affiliation":[{"name":"Arthritis Research Canada Richmond BC Canada"},{"name":"Division of Rheumatology, Allergy, and Immunology, Department of Medicine Massachusetts General Hospital, Harvard Medical School Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyon K","family":"Choi","sequence":"additional","affiliation":[{"name":"The Mongan Institute, Massachusetts General Hospital, Harvard Medical School Boston MA USA"},{"name":"Division of Rheumatology, Allergy, and Immunology, Department of Medicine Massachusetts General Hospital, Harvard Medical School Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guanghua","family":"Lei","sequence":"additional","affiliation":[{"name":"National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University Changsha China"},{"name":"Department of Orthopaedics Xiangya Hospital, Central South University Changsha China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7638-0888","authenticated-orcid":false,"given":"Yuqing","family":"Zhang","sequence":"additional","affiliation":[{"name":"The 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