Pain medication tramadol is tied to greater odds of hip fractures when compared with codeine and common nonsteroidal anti-inflammatory drugs, a new analysis has found.

Tramadol is widely recommended as a therapy for patients with chronic noncancer pain, but aspects of its safety profile remain uncertain, said investigators. The study team compared one-year outcomes between adults who used the drug and patients who took codeine, naproxen, ibuprofen, celecoxib and etoricoxib. Participants were 50 years old or older.

Patients taking tramadol had more hip fractures than their peers who used the opiate codeine. They also experienced more hip fractures than participants who took any of the NSAIDs, reported Yuqing Zhang, DSc, from Harvard Medical School.

Clinicians may wish to revisit the guidelines on tramadol use when treating patients for pain, Zhang and colleagues noted.

“Considering the significant impact of hip fracture on morbidity, mortality, and healthcare costs, our results point to the need to consider tramadol’s associated risk of fracture in clinical practice and treatment guidelines,” the researchers concluded.

The study was published in the Journal of Bone and Mineral Research.