Tramadol linked to lower death and fracture risks than some opioids
For tramadol, death hazard ratios—comparisons of rates over time—were 0.93 versus codeine, 0.81 versus hydrocodone and 0.40 versus oxycodone.
Limit: Longer-term death and fracture risks are missing from the reported results
Edited by Boris Djordjevic · AgingResearch.News
A retrospective observational study included 1,057,635 adults aged 50 or older with osteoarthritis who started tramadol, codeine, hydrocodone or oxycodone. Their mean age was 69.1 years, and 62.5% were female. Researchers analyzed records from 2005–2021 and used statistical weighting to balance the groups’ starting characteristics.
During follow-up, 9,988 deaths and 10,455 fractures occurred. Tramadol was associated with lower death and fracture risks than hydrocodone or oxycodone, but similar risks to codeine. For fractures, hazard ratios were 0.91 versus hydrocodone, 0.83 versus oxycodone and 1.10 versus codeine. A hazard ratio below one indicates a lower event rate. The uncertainty ranges for both comparisons with codeine included no difference.
Why it matters
Choosing pain medicines for older adults with osteoarthritis involves weighing death and fracture risks. The findings suggest tramadol may be a comparatively favorable option when an opioid is necessary.
Caveats
This observational study cannot establish that tramadol caused the lower risks. The findings concern adults aged 50 or older with osteoarthritis starting opioids; longer-term comparative safety remains uncertain.
The paper
Brigham and Women's Hospital
Arthritis & Rheumatology, Oct 27, 2026
