Study: After Fragility Fracture, Patients Often Continue Meds That Increase Fracture Risk

Few receive drugs that increase bone density

Older patients who experience fragility fractures are often receiving medications that can increase their fracture risk––and even after an accident, less than 10% of them stop taking those drugs, according to a new study published in JAMA Internal Medicine.

Researchers led by a team at the Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire, conducted a retrospective cohort study between February 2015 and March 2016 using a random sample of Medicare beneficiaries from 2007 through 2011 in communities throughout the United States. A total of 168,133 community-dwelling Medicare beneficiaries who survived a fragility fracture of the hip, shoulder, or wrist were included. The patients’ mean age was 80 years.

Most patients were exposed to at least one nonopiate drug associated with increased fracture risk in the four months before fracture (77% of hip, 74% of wrist, and 76% of shoulder fractures). Approximately 7% of these patients discontinued this drug exposure after the fracture, but this was offset by new users after fracture, the authors noted. Consequently, the proportion of the cohort exposed after fracture was unchanged (81%, 74%, and 77% for hip, wrist, and shoulder, respectively). There was no change in the average number of fracture-associated drugs used. The use of drugs to strengthen bone density was uncommon (less than or equal to 25%) both before and after a fracture.

“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,” lead author Dr. Jeffrey C. Munson told Reuters. “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.”

Fragility fractures are common in the elderly and can lead to pain, hospitalization, and loss of function and independence––particularly hip fractures, which have a high mortality rate, Munson said.

Dr. Sarah D. Berry of the Institute for Aging Research at Hebrew SeniorLife in Boston, Massachusetts, coauthored an editorial that accompanied the article. “Some drugs affect balance and memory, like sleeping pills, which can lead to a fall,” she told Reuters in an email.

Blood pressure medications cause changes in blood pressure that could lead to a fall, Berry said. In addition, drugs such as prednisone or medications for heartburn can increase bone loss, which can lead to a fracture.

“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,” Berry said.

Which drugs can be stopped will vary from case to case, according to Munson.

“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.”

Sources: Reuters Health News; August 22, 2016; and JAMA Internal Medicine; August 22, 2016.