Drugs affecting postural stability and other risk factors in the hip fracture epidemic — case-control study

Stevens, Andrew; Mulrow, Cynthia D.

doi:10.1093/oxfordjournals.pubmed.a042443

Cited by 16 publications

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“…No association between narcotic use and injury was found, although this has been reported previously in the elderly as a risk for motor vehicle injuries and hip fractures [Stevens and Mulrow, 1989;Leveille et al, 19941. Narcotics are frequently prescribed to relieve pain from injury, thus valid determination of dates of injury and receipt of medication is particularly important when evaluating the relationship between narcotics and injuries.…”

Section: Or' 95% CI ("H) (%) Or' 95% Ci ("H) (%) Or' 95% Cimentioning

confidence: 52%

“…Workers employed in industries with the highest rates of injury are underrepresented in the GHC population. [Tinetti et al, 1988;Oster et al, 1990;Ray et al, 1987Ray et al, , 1989Ray et al, , 1992Sorock, 1988;Stevens and Mulrow, 1989;Leveille et al, 19941. The antihistamines considered in this study were almost exclusively sedating, as the newer, less sedating antihistamines were not on the GHC formulary during the study period.…”

Section: Discuss I0 Nmentioning

confidence: 99%

“…For people between the ages of 20 and 64 years, approximately one-third of all injuries and about one-sixth of all deaths occur at work [CDC, 19891. Alcohol and illicit drug use can increase the risk of injury in the workplace, and studies have shown that over 10% of fatal occupational injury victims had measurable blood alcohol [Lewis and Cooper, 1989;Alleyene et al, 19911. Medication use and associated medical conditions have been linked to increased risk of injury from falls and motor vehicle crashes in the elderly Tinetti et al, 1988;Oster et a]., 1990; Ray et al, 1987Ray et al, , 1989Ray et al, , 1992Sorock, 1988;Stevens and Mulrow, 1989;Leveille et al, 19941. Associations have been found for benzodiazepines, tricyclic antidepressants, narcotics, insulin and oral hypoglycemics, and loop diuretics.…”

Section: Introductionmentioning

confidence: 99%

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Occupational injuries and medication use

et al. 1996

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Recent medication use of 3,394 members of the Group Health Cooperative of Puget Sound (GHC) diagnosed with an incident work‐related injury was compared to that of two controls selected from the GHC membership and matched on age, gender, and Standard Industrial Classification Code of their employer. Medication use was determined from the GHC pharmacy data base. The injuries of the cases included 496 fractures or dislocations, 2, 728 open wounds, crushing injuries, or superficial injuries, 176 burns, and 64 internal or intracranial injuries. The risk of injury was elevated among users of antihistamines [odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.1‐1.9], antibiotics (OR = 1.2, 95C% Cl = 1.0‐1.5), and diabetes medications (OR = 1.3, 95% CI = 0.9‐1.9). The patterns of risk were similar for males and females, but varied by type of injury. No consistent associations between use of antidepressants, antianxiety medication, or narcotics and work‐relaled injury were observed. The use of some medications, or conditions requiring medications, may contribute to the risk of a work‐related injury. © 1996 Wiley‐Liss, Inc.

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Section: Or' 95% CI ("H) (%) Or' 95% Ci ("H) (%) Or' 95% Cimentioning

confidence: 52%

Section: Discuss I0 Nmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Occupational injuries and medication use

et al. 1996

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“…These include retrospective case-control studies comparing characteristics of hip fracture patients with age-and sex-matched control subjects, [2][3][4][5][6][7][8][9][10][11][12] prospective cohort studies of population samples followed up to identify subsequent hip fractures, [13][14][15][16] and cross-sectional studies in which questionnaires were sent to large numbers of people to ascertain how often stroke and hip fractures occur in the same individual. 17,18 These suggest, with only 1 exception, 14 that stroke is a risk factor for subsequent hip fracture, with most studies reporting risk (or odds) ratios of between 1.5 and 4.…”

mentioning

confidence: 99%

Fractures After Stroke

Dennis

McDowall

et al. 2002

Stroke

166

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Background and Purpose-Stroke patients may have an increased risk of fractures because of weak bones or an increased risk of falling. Our goal was to estimate the frequency of fracture after stroke and to identify those at greatest risk. Methods-This study incorporated 2 complementary strategies: a prospective, single-center, cohort study and an analysis of Scottish routine hospital discharge data. Results-Eighty-eight fractures (30% hip) occurred in 2696 hospital-referred stroke patients. The proportions sustaining any fracture or hip fracture within 2 years were 4% and 1.1%, respectively, 1.4 (95% CI, 0.92 to 2.07) times the rate of hip fracture in the general population (ie, observed number divided by expected number or standardized morbidity ratio). Female sex, older age, low abbreviated mental test score, and prestroke dependence were associated with an increased hip fracture rate. Routine data identified 129 935 acute stroke patients admitted to Scottish hospitals. During 363 447 patient-years, 4528 patients had hip fractures, 2.0% had fractures by 1 year, and 10.6% had fractures by 10 years. This is 1.7 times the rate of hip fracture in the general population and 2.3 times that in patients with myocardial infarction. Older patients predictably had the highest rate of poststroke hip fractures but a lower standardized morbidity ratio than younger patients. Conclusions-Fractures after stroke are probably frequent and serious enough to justify the development of preventive strategies, but the modest event rate would mean that randomized, controlled trials to test these strategies specifically in stroke patients would need to enroll thousands of patients.

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“…Two case-control studies in men found no association between hip fractures and stroke per se, but fracture risk was elevated 2.4-to 2.6-fold in the presence of hemiplegia or hemiparesis [4,5]. Some investigators have reported a similar association with stroke among women [6][7][8], but most workers have not identified stroke as an important determinant of hip fractures in women [9][10][11][12][13][14][15][16] or of distal forearm [17][18][19] or vertebral fractures [20][21][22][23] in older individuals of either sex. However, none of these other studies focused on stroke, and most of them involved interviews with volunteers so that stroke patients may have been underrepresented.…”

Section: Introductionmentioning

confidence: 98%

Long-Term Fracture Risk Following Ischemic Stroke: A Population-Based Study

Melton¹,

Brown

Achenbach³

et al. 2001

Osteoporosis International

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The overall risk of fracture following stroke has not been well quantified. We addressed this issue in a population-based retrospective cohort study among the 387 Rochester, Minnesota residents who survived for 90 days following their first cerebral infarction during the 10-year period, 1960-69. Cases were matched by age and sex to controls from the general population of Rochester, and subsequent fractures were assessed through review of each subject's complete (inpatient and outpatient) medical records in the community. With comparable follow-up, the 128 fractures observed among cases were little more than the 118 seen among controls, and the cumulative incidence of any fracture after 25 years was not significantly different (71% versus 66%; p=0.464). Using stratified Cox analysis, there was no increase in the risk of fractures generally (hazard ratio (HR), 1.1; 95% CI, 0.8-1.6) or hip fractures specifically (HR, 1.1; 95% CI, 0.6-2.1) compared with controls. Among the stroke patients with hemiparesis or hemiplegia, the majority of fractures occurred on the impaired side. In a multivariate analysis, fracture risk increased with age (HR per 10 years, 1.6; 95% CI, 1.4-2.0), with hospitalization at onset of stroke (HR, 2.0; 95% CI, 1.3-3.2) and with moderate functional impairment (HR, 1.6; 95% CI, 1.02-2.5) but not severe disability (HR, 0.8; 95% CI, 0.4-1.6). No other characteristic of the stroke or its treatment was an independent predictor of overall fracture risk. Patients and their caretakers need to be aware of the risk of fracture from falls, particularly when moderate impairment permits the patient to be independently mobile.

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Drugs affecting postural stability and other risk factors in the hip fracture epidemic — case-control study

Cited by 16 publications

References 0 publications

Occupational injuries and medication use

Occupational injuries and medication use

Fractures After Stroke

Long-Term Fracture Risk Following Ischemic Stroke: A Population-Based Study

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