- Fracture-associated drugs (FADs), such as opioids and proton pump inhibitors, are commonly used by elderly and commonly combined.
- When combined, hip fracture risk is dramatically increased.
Why this matters
- Findings, if confirmed, suggest that fracture risk can be lowered by greater adherence to prescribing guidelines, and recommendations.
- Cohort study employed a 20% random sample of Medicare fee-for-service administrative data set (2004-2014), totaling 11.3 million person-years of observation.
- Funding: NIH; other.
- 25.05% of cohort received 1 FAD, 11.72% received 2 FADs, and 8.46% received ≥3 FADs.
- FADs increase fracture risk (vs no FADs): 1 FAD: HR, 2.04 (P<.001 fads: hr>
- Vs no FADs, common, risky pairs include sedative hypnotics+opioids: HR, 4.90; selective serotonin reuptake inhibitors (SSRIs)+benzodiazepines: HR, 4.50; proton pump inhibitors+opioids: HR, 4.00 (all Ps<.001>
- FADs increase fracture risk (vs no FADs): 1 FAD: HR, 2.23 (P<.001 fads: hr>
- Vs no FADs, common, risky pairs include opioids+loop diuretics: HR, 6.93 (95% CI, 5.52-8.70); opioids+SSRIs/serotonin-norepinephrine reuptake inhibitors: HR, 6.26 (95% CI, 4.83-8.12); proton pump inhibitors+opioids: HR, 4.97 (95% CI, 3.92-6.29).
- Retrospective, observational design.
- Findings not necessarily applicable to all elderly.