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90 percent of older people who break a bone continue medications that that boost fracture risk (2016-09-01)

Patients who have a fragility fracture are at high risk for subsequent fractures and prescription drugs represent one factor that could be modified to reduce the risk of subsequent fracture: even after an accident, less than 10 percent of them stop taking those drugs, according to a new study.

A retrospective cohort study was conducted between February 2015 and March 2016, 168.133 community-dwelling Medicare beneficiaries, on average age 80, who survived a fracture of the hip, shoulder and the authors compared their records with retail pharmacy claims to identify which patients had been taking medicines that increase the risk of a fall, decrease bone density or are otherwise tied to an increased risk of fracture.

A total of 168.133 patients with a fragility fracture (141.569 women; 84.2%) met the inclusion criteria for this study; 91.8% were white.

Across all fracture types, the mean age was 80.0 years, and 53.2% of the fracture cohort was hospitalized at the time of the index fracture, although this varied significantly depending on fracture type (100% of hip fractures, 8.2% of wrist fractures, and 15.0% of shoulder fractures).

The frequency of discharge to an institution for rehabilitation following hospitalization also varied by fracture type, but the mean duration of acute rehabilitation did not: 28.1 (19.8) days.

Most patients were exposed to at least 1 nonopiate drug associated with increased fracture risk in the 4 months before fracture (77.1% of hip, 74.1% of wrist, and 75.9% of shoulder fractures).

Approximately 7% of these patients discontinued this drug exposure after the fracture, but this was offset by new users after fracture.
Consequently, the proportion of the cohort exposed following fracture was unchanged (80.5%, 74.3%, and 76.9% for hip, wrist, and shoulder, respectively).

There was no change in the average number of fracture-associated drugs used.

This same pattern of use before and after fracture was observed across all 3 drug mechanism categories. Use of drugs to strengthen bone density was uncommon (=25%) both before and after fracture.

Some drugs affect balance and memory, like the sleeping pills, which can lead to a fall, blood pressure medications cause changes in blood pressure that could lead to a fall while other drugs, like prednisone or medications for heartburn, increase bone loss which can lead to a fracture.

For many of the studied drugs, there are alternative drugs that treat the same conditions but with a lower risk of fracture, and in other cases, it may be possible to eliminate a drug altogether, researchers said.

For more information
Patterns of Prescription Drug Use Before and After Fragility Fracture
Jeffrey C. Munson, MD, MSCE; Julie P. W. Bynum, MD, MPH; John-Erik Bell, MD, MS; Robert Cantu, MD, MS; Christine McDonough, PT, PhD; Qianfei Wang, MS; Tor D. Tosteson, ScD; Anna N. A. Tosteson, ScD.