Association between the use of benzodiazepines and opioids with the risk of falls and hip fractures in older adults

Machado‐Duque, Manuel Enrique; Castaño-Montoya, Juan Pablo; Medina-Morales, Diego Alejandro; Castro-Rodríguez, Alejandro; González-Montoya, Alexandra; Machado‐Alba, Jorge Enrique

doi:10.1017/s1041610217002745

Cited by 50 publications

(36 citation statements)

References 37 publications

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“…Moreover, we observed an association among opioids, antidepressants, antipsychotics and fractures. These findings are in line with previous studies in a general population and linked to the sedative effects that are specific to this class of drugs again increasing the risk of falls 30‐32 . Prolonged intake of steroids is a well‐established risk factor for osteoporosis by inhibition of osteogenesis.…”

Section: Discussionsupporting

confidence: 90%

Proton pump inhibitors increase risk of bone fractures in men with cirrhosis: a population‐based study

Labenz

Wörns

Adarkwah

et al. 2020

Aliment Pharmacol Ther

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SummaryBackgroundBone fractures are a frequent complication in patients with cirrhosis. Proton pump inhibitors (PPIs) are among the most frequently prescribed medications and may impair bone quality and quantity.AimsTo investigate whether PPI use predisposes patients with cirrhosis to bone fractures.MethodsWe performed a population‐based case‐control study exploring a sample of patients with cirrhosis derived from the Disease Analyzer database. In total, 1795 cirrhotic patients with fractures were compared to 10 235 cirrhotic patients without fractures. PPI use overall and the cumulative PPI dose 5 years prior to the index date were analysed. To estimate the association between PPI use and fractures, logistic regression analyses were performed taking cofounding factors into consideration.ResultsPPI use was more frequently seen in cirrhotic patients with fractures compared to controls (67.0% vs 53.4%, P < 0.001). In regression analyses, PPI use was associated with bone fractures after adjusting for important confounders (OR 1.34, 95% CI 1.20‐1.51, P < 0.001). Importantly, the strongest effect of PPIs on bone fractures was seen in men and patients below 70 years of age. On further sensitivity analyses, we observed a dose‐dependent effect for all PPIs with the strongest effect in cirrhotic patients receiving a dose of >50 000 mg during the 5 years prior to index date (OR 1.63, 95% CI 1.32‐2.03).ConclusionsPPI use was associated with bone fractures in a dose‐dependent fashion in patients with cirrhosis. PPI use in these patients should be based on a careful risk‐benefit assessment.

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Section: Discussionsupporting

confidence: 90%

Proton pump inhibitors increase risk of bone fractures in men with cirrhosis: a population‐based study

Labenz

Wörns

Adarkwah

et al. 2020

Aliment Pharmacol Ther

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“…The use of opioids is related to adverse reactions such as confusion, hallucinations, delirium or sedation and therefore may be associated with an increased risk of falls [24]. In Colombia, it was found that the use of opioids (OR: 4.49, 95% CI: 2.72-7.42) was significantly associated with an increased risk of suffering a fall and presenting a hip fracture [25], which could happen with the opioids prescribed to hospital discharge, generating greater morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Consistency between anticholinergic burden scales in the elderly with fractures

et al. 2020

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Objective Falls and bone fractures are important causes of morbidity and mortality in the elderly. The objective of this study was to identify the degree of consistency between the anticholinergic scales used for patients diagnosed with fractures. Methods This was an analytical agreement study conducted in patients diagnosed with vertebral and nonvertebral fractures in Colombia. The quadratic-weighted kappa coefficient was used to identify the consistency between the Anticholinergic Drug Scale-ADS, Anticholinergic Cognitive Burden Scale-ACB and Anticholinergic Risk Scale-ARS in assessing the prescriptions of fracture patients during the month prior to the fracture, during their stay as an inpatient and at discharge, according to Landis criteria. Results 220 patients with fractures were included, with a mean age of 75.3±10.3 years, and 68.2% were women. The ACB scale identified the highest anticholinergic burden (26.8%) in prescriptions made the month before the fracture, and the highest agreement was between ACB and ADS (0.717); during hospitalization and at discharge, the cholinergic antagonists were best identified with ADS (77.7% and 72.1%, respectively), with the best agreement between ACB and ARS (0.613 and 0.568, respectively). The prescription of tramadol was found in 64.1% of hospitalized patients and in 61.4% of patients at the time of discharge. Conclusions The scales evaluated show marked discrepancies between them, with highly variable frequencies of anticholinergic drugs identified at the different prescription times, and with low

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“…Also, the use of potentially inappropriate medications (i.e. benzodiazepines, antipsychotics, antidepressants) may be the cause of increased fall risk (35,36). While some studies denoted independent relation between falls and insomnia (18,36), more studies denoted that the relation between falls and insomnia revealed nonsignificant after adjustment with potential confounders (18,37).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Self-reported Insomnia and Its Association with Some Geriatric Syndromes in Older Adults

Türkmen¹

2019

ejgg

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Association between the use of benzodiazepines and opioids with the risk of falls and hip fractures in older adults

Abstract: People who are taking opioids and benzodiazepines have increased risk for hip fracture in Colombia. Strategies to educate physicians regarding the pharmacology of older adults should be strengthened.

Cited by 50 publications

References 37 publications

Proton pump inhibitors increase risk of bone fractures in men with cirrhosis: a population‐based study

Proton pump inhibitors increase risk of bone fractures in men with cirrhosis: a population‐based study

Consistency between anticholinergic burden scales in the elderly with fractures

Evaluation of Self-reported Insomnia and Its Association with Some Geriatric Syndromes in Older Adults

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