{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T17:55:46Z","timestamp":1771264546718,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T00:00:00Z","timestamp":1690156800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005217","name":"National Center for Injury Prevention and Control","doi-asserted-by":"publisher","award":["R49 CE003095"],"award-info":[{"award-number":["R49 CE003095"]}],"id":[{"id":"10.13039\/100005217","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Study Objective<\/jats:title><jats:p>The objective of this work is to describe the risk of fracture in adults aged 17 to 64\u2009years across categories of daily opioid dose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A retrospective analysis of insurance claims data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data source<\/jats:title><jats:p>Information from a private health insurance provider for the years 2003\u20132014 for enrolled individuals living in Iowa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>Patients who were aged 17 to 64\u2009years and prescribed an opioid were followed for the length of opioid treatment plus 30\u2009days to determine whether a fracture occurred.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Average daily morphine milligram equivalent (MME) was determined for patients who received a prescription for opioids. The outcome of interest was incident fracture following opioid treatment initiation. Cox proportional hazard models were used to compare the risk of fracture across categorical groups of average daily MME. Inverse probability weighting was used to control for patient\u2010level variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Results<\/jats:title><jats:p>In total, 316,024 individual patients were identified in the administrative claims data as having an opioid prescription from 2003 to 2014, and 3038 fractures occurred during follow\u2010up (9.6 fractures per 1000 opioid\u2010prescribed patients). Relative to the lowest quartile of prescribed opioid (\u27e822\u2009MME), patients in each higher prescribed level were more likely to experience a fracture (22\u201336\u2009MME Hazard Ratio (HR)\u2009=\u20091.35, 95% Confidence Interval (CI): 1.21\u20131.51; 37\u201350\u2009MME HR\u2009=\u20091.38, 95% CI: 1.24\u20131.54; \u27e950\u2009MME HR\u2009=\u20091.35, 95% CI: 1.20\u20131.52).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We observed an increased fracture risk in all three higher categories of opioid exposure relative to the lowest category (\u27e822\u2009MME). The risk of a fracture should be considered in opioid treatment decisions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2849","type":"journal-article","created":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T04:10:35Z","timestamp":1689567035000},"page":"913-921","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Fracture risk and opioid use in patients aged 17\u201364\u2009years: An analysis of administrative claims data"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5164-1241","authenticated-orcid":false,"given":"Jonathan","family":"Davis","sequence":"first","affiliation":[{"name":"Department of Occupational and Environmental Health University of Iowa College of Public Health  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carri","family":"Casteel","sequence":"additional","affiliation":[{"name":"Department of Occupational and 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