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 “One would expect that a significant health event like a fracture
would result in some change in the use of prescription drugs that
might have contributed to that event,” said lead author Dr. Jeffrey
C. Munson of the Geisel School of Medicine at Dartmouth in Lebanon,
New Hampshire. “In contrast to this expectation, we observed that
for the overwhelming majority of patients we studied, a fragility
fracture did not lead to any change in medications that have been
linked to fracture risk.”
The authors used data on 168,000 Medicare beneficiaries, more than
80 percent of whom were women, on average age 80, who had
experienced a hip, shoulder or wrist fracture. They compared these
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.
Fragility fractures are common for the elderly and can lead to
hospitalization, pain, and loss of function and independence –
particularly hip fractures, which have a high mortality rate, Munson
said.
About 75 percent of fracture patients had been taking one of these
medications. While seven percent of people stopped taking the
medication after their fracture, a similar number started to take a
new medication also tied to fracture risk, the authors reported in
JAMA Internal Medicine.
“Some drugs affect balance and memory, like the sleeping pills,
which can lead to a fall,” said Dr. Sarah D. Berry of the Institute
for Aging Research at Hebrew SeniorLife in Boston, Massachusetts,
who coauthored an editorial alongside the results.
Blood pressure medications cause changes in blood pressure that
could lead to a fall. Berry said. Other drugs, like prednisone or
medications for heartburn, increase bone loss which can lead to a
fracture, she told Reuters Health by email.
“Fractures are the leading cause of death from injury and one of the
main reasons for nursing home placement in persons over the age of
65,” she said.
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“When a patient has a hip, shoulder or wrist fracture, it is
important for healthcare providers to examine all the prescription
medications he or she is taking, and carefully assess whether there
is an opportunity to eliminate those that might cause a future
fracture,” Munson told Reuters Health by email.
However, he said, “In many cases, the benefits of a drug may
outweigh its risks, even when those risks are significant.”
Which drugs can be stopped will vary from case to case, Munson
noted.
“For many of the drugs we studied, there are alternative drugs that
treat the same conditions but with a lower risk of fracture,” he
said. “In other cases, it may be possible to eliminate a drug
altogether.”
SOURCE: http://bit.ly/2bc6PIN JAMA Internal Medicine, online August
22, 2016.
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