Hip fracture increased by use of multiple, concurrent fracture-associated drugs

  • Emeny RT & al.
  • JAMA Netw Open
  • 01/11/2019

  • Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 25.05% of cohort received 1 FAD, 11.72% received 2 FADs, and 8.46% received ≥3 FADs.
  • Women:
    • 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>
  • Men:
    • 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).

Limitations

  • Retrospective, observational design.
  • Findings not necessarily applicable to all elderly.