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,
For more information
Patterns of Prescription Drug Use Before and After
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.