Study: Beta blockers associated with increase in nonunion for fracture
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LAS VEGAS — Use of beta blockers after fracture was associated with an increase in the incidence of nonunion, according to data presented at the American Academy of Orthopaedic Surgeons Annual Meeting.
“We observed an association with beta blocker exposure and nonunion following fracture which would be counter to some of the conclusions from the basic science literature. Overall, the challenge in these large observational studies remains the difficulty in determining what is medication effect vs. a reflection of the patient’s overall health status that cannot be completely captured by the comorbidity index and our attempts to control for confounders through statistical methods,” Lillia Steffenson, MD, said, here.
In the retrospective study using a Medicare database, Steffenson and colleagues identified fee-for-service Medicare beneficiaries who had fractures of the humerus, forearm, tibia/fibula or femur as identified by ICD-10 and CPT codes during the 4-year study period. Steffenson said patients were excluded if they had Medicare because of end-stage renal disease, Social Security Disability Insurance or if they did not have part B coverage or at least one of the claims prior to and after the index fracture.
Researchers identified nonunion by ICD-10 or CPT codes during inpatient, hospital outpatient and part B Medicare claims during a 1-year period after the index fracture. Beta blocker exposure was based on part D pharmacy claims that occurred between 90 days prior to the index fracture to 1 year after the index fracture.
Researchers identified 253,266 fractures that met the inclusion criteria, and the overall nonunion prevalence in this cohort was 3.9%, Steffenson said.
“Patients taking beta blockers and statins were more often male, African American and had a higher comorbidity index,” Steffenson said.
After controlling for sex, age and comorbidity, researchers found a 13% higher incidence in nonunion for patients taking beta blockers.
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Steffenson L, et al. Paper #12. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 7-11, 2023; Las Vegas.
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