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Prescription drugs linked with fractures are rarely reduced after fragility fracture
Researchers recommend patients be treated with osteoporosis medications to prevent future fractures.
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Patients who were prescribed at least one medication that increased their fracture risk did not have that medication reduced following a fragility fracture, according to results published in JAMA Internal Medicine.
“Prescription drugs that are associated with fractures are commonly used by elderly people, and it does not appear that when patients have a fracture, physicians do much to change that,” Jeffrey C. Munson, MD, MSCE, assistant professor of medicine at the Geisel School of Medicine at Dartmouth, told Orthopedics Today. “What we found is that the use of medications that are known to increase the risk of fracture was the same before and after patients have had a fracture.”
Identification of risk for fracture
Munson and his colleagues wrote that identifying patients at risk for fractures is urgent, noting that fragility fractures are associated with annual costs of more than $16 billion.
“One clearly defined high-risk population is survivors of a first fragility fracture,” they wrote. “Not only are such patients at significantly increased risk of experiencing a second fracture, the incidence is highest in the first 6 months after a first fracture, highlighting the importance of identifying modifiable risk factors and interventions that can be implemented immediately after an index fragility fracture.”
The researchers conducted a retrospective cohort study of 168,133 Medicare beneficiaries who sustained a wrist, shoulder or hip fracture. The researchers analyzed prescription fills for various drugs that increase fall risk, decrease bone density, increase bone density and have unclear fracture risk mechanisms.
Exposure may increase risk
Researchers reported about 76% of patients who had a fragility fracture were exposed to at least one non-opiate drug associated with increased fracture risk in the 4 months prior to their fracture. This was the same across studies of different fracture types (hip, wrist, shoulder). At the same time, bone density-strengthening drugs were used in less than 25% of patients both before and after fracture.
About 7% of patients stopped using these high-risk drugs following the fracture, but researchers reported this decrease was mitigated by new patients using drugs following a fracture. After a fragility fracture, 80.5% of patients with hip fractures, 74.3% of patients with wrist fractures and 76.9% of patients with shoulder fractures were exposed to drugs associated with an increased fracture risk.
“The use of drugs that can contribute to elevated fracture risk is common among Medicare beneficiaries who experience a fragility fracture, and the fracture event does not consistently lead to a reduction in use of these drugs,” the researchers wrote. “This suggests that at least some secondary fragility fractures may be preventable through a more concerted effort to manage high-risk drugs around a primary fracture event.”
Munson added, “What this means is that physicians need to be conscientious about reviewing a patient’s medication list when they have an event like a fracture to see if there are ways we can reduce their risk of having a second fracture. We know these patients are at high risk to have subsequent fractures, and this is a good opportunity to run through the medications they have and see which ones can be stopped.”– by Chelsea Frajerman Pardes and Nhu Te
- Reference:
- Munson JC, et al. JAMA Intern Med. 2016;doi:10.1001/jamainternmed.2016.4814.
- For more information:
- Jeffrey C. Munson, MD, MSCE, can be reached at the Dartmouth Institute, 1 Rope Ferry Rd., Hanover, NH 03755; email: jeffrey.c.munson@dartmouth.edu.
Disclosure: Munson reports no relevant financial disclosures.