Comparative risks of mortality and fractures in patients with osteoarthritis initiating tramadol versus other opioids
Authors' conclusion
In adults aged 50 years or older with osteoarthritis initiating an opioid, tramadol initiation was associated with lower risks of mortality and fractures compared with hydrocodone and oxycodone, and similar risks compared with codeine. These findings suggest that tramadol may be a comparatively favorable option when opioid therapy is necessary, although its longer-term comparative safety remains uncertain.
Study context
- Population
- Adults aged ≥50 years with osteoarthritis initiating tramadol, codeine, hydrocodone, or oxycodone, Optum Clinformatics® Data Mart (2005–2021)mean age 69.1 years, 62.5% female
- Participants
- 1,057,635 adults
- Exposure
- Tramadol versus other prescribed opioids
- Tramadoln = 294,760
- Codeinen = 97,048reference
- Hydrocodonen = 474,733reference
- Oxycodonen = 191,094reference
- Outcome
- All-cause mortality
Methodological detailsPropensity score weighting, weighted Cox proportional hazards models
- Propensity score weighting
- Weighted Cox proportional hazards models
Main finding
As reported in the abstract
Hazard ratio (95% CI)
Tramadolvs Codeinesimilar mortality risk
0.93(0.73–1.19)
Tramadolvs Hydrocodonelower risk
0.81(0.70–0.93)
Tramadolvs Oxycodonelower risk
0.40(0.34–0.47)
- Deaths during follow-up
- 9,988
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| FracturesTramadolvs CodeineComparable | 1.10 (0.96–1.25) | |
| FracturesTramadolvs Hydrocodone | 0.91 (0.83–0.98) | |
| FracturesTramadolvs Oxycodone | 0.83 (0.75–0.93) | |
| 0.512Hazard ratio (log scale) |
- Fractures — Fractures during follow-up
- 10,455
Original publication
Comparative risks of mortality and fractures in patients with osteoarthritis initiating tramadol versus other opioids. Arthritis Rheumatol. Published 27 October 2026. doi:10.
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