Risk of fractures among patients with postherpetic neuralgia receiving pregabalin: real-world evidence from Taiwan

ABSTRACT: This study investigated the association between pregabalin use and fracture risk in patients with postherpetic neuralgia (PHN) newly diagnosed between 2012 and 2021 in Taiwan. Patients treated with pregabalin formed the exposed group, whereas those not receiving pregabalin served as controls, with propensity score matching applied (1:3 ratio). Incident traumatic fractures were assessed over 30 days using Firth's logistic regression, with sensitivity analyses by dosage and time intervals. Patients on pregabalin had a higher fracture risk (adjusted odds ratio [aOR] = 1.51; 95% confidence interval [CI] = 1.07-2.15) compared to controls. By dosage, aORs were 1.54 (95% CI = 1.08-2.19) for ≤150 mg and 1.38 (95% CI = 0.59-3.23) for >150 mg. Fracture risks were elevated at 1 to 7 days (aOR = 2.10; 95% CI = 1.15-3.84) and 22 to 28 days (aOR = 2.31; 95% CI = 1.25-4.25), but not significantly at 8 to 14 or 15 to 21 days. Patients with PHN on pregabalin showed increased fracture risk, particularly at lower doses and during early/late treatment periods, without a clear dose-response relationship. Clinicians should monitor fracture risk in patients with PHN, even with low-dose or short-term pregabalin use.