Is use of fall risk-increasing drugs in an elderly population associated with an increased risk of hip fracture, after adjustment for multimorbidity level: a cohort study

Abstract

BackgroundRisk factors for hip fracture are well studied because of the negative impact on patients and the community, with mortality in the first year being almost 30% in the elderly. Age, gender and fall risk-increasing drugs, identified by the National Board of Health and Welfare in Sweden, are well known risk factors for hip fracture, but how multimorbidity level affects the risk of hip fracture during use of fall risk-increasing drugs is to our knowledge not as well studied. This study explored the relationship between use of fall risk-increasing drugs in combination with multimorbidity level and risk of hip fracture in an elderly population.MethodsData were from Östergötland County, Sweden, and comprised the total population in the county aged 75 years and older during 2006. The odds ratio (OR) for hip fracture during use of fall risk-increasing drugs was calculated by multivariate logistic regression, adjusted for age, gender and individual multimorbidity level. Multimorbidity level was estimated with the Johns Hopkins ACG Case-Mix System and grouped into six Resource Utilization Bands (RUBs 0–5).Results2.07% of the study population (N = 38,407) had a hip fracture during 2007. Patients using opioids (OR 1.56, 95% CI 1.34-1.82), dopaminergic agents (OR 1.78, 95% CI 1.24-2.55), anxiolytics (OR 1.31, 95% CI 1.11-1.54), antidepressants (OR 1.66, 95% CI 1.42-1.95) or hypnotics/sedatives (OR 1.31, 95% CI 1.13-1.52) had increased ORs for hip fracture after adjustment for age, gender and multimorbidity level. Vasodilators used in cardiac diseases, antihypertensive agents, diuretics, beta-blocking agents, calcium channel blockers and renin-angiotensin system inhibitors were not associated with an increased OR for hip fracture after adjustment for age, gender and multimorbidity level.ConclusionsUse of fall risk-increasing drugs such as opioids, dopaminergic agents, anxiolytics, antidepressants and hypnotics/sedatives increases the risk of hip fracture after adjustment for age, gender and multimorbidity level. Fall risk-increasing drugs, high age, female gender and multimorbidity level, can be used to identify high-risk patients who could benefit from a medication review to reduce the risk of hip fracture.

Hypertension, Antihypertensive Drugs and the Risk of Fractures

“…A population-based case-control study found a decreased risk of any fracture in those aged [70 years with reduced risk estimates in most dosage groups, but no statistically significant dose-response relationship [43], whereas an increased fracture risk in both women (HR 1.22, 95 % CI 1.14-1.30) and men (HR 1.29, 95 % CI 1.15-1.45) was observed in a retrospective cohort study where BBs users were the reference standard [36]. In another retrospective cohort study, ACE inhibitors and ARBs were not associated with an increased hip fracture risk (OR 0.93, 95 % CI 0.79-1.09) [44]. It appears that ARBs may have a protective effect on bone and chronic ARB users are more likely to have reduced fracture risk compared to users of ACE inhibitors where the evidence still remains uncertain.…”

“…The use of nondihydropyridine drugs was associated with a larger risk reduction than the use of dihydropyridine drugs [43]. Also, CCBs were found to have no association with hip fracture risk (OR 0.83, 95 % CI 0.69-1.00) when compared to nonusers in a register-based retrospective cohort study [44]. The evidence regarding the association between CCBs and fracture risk is mixed, and further research is needed to determine its effect on bone.…”

“…However, two observational studies published since 2014 have provided conflicting results regarding the association of BBs with fracture risk. One retrospective cohort study conducted in Sweden on 38,407 subjects aged C75 years demonstrated that BBs were not associated with hip fracture risk (OR 0.92, 95 % CI 0.80-1.07) [44]. In another nationwide population-based retrospective cohort study conducted in South Korea on 527,500 newly treated hypertensive subjects, BBs were associated with an increased fracture risk (HR 1.15, 95 % CI, 1.03-1.28) [41].…”

Opioids in hip fracture patients: An analysis of mortality and post hospital opioid use

“…The elderly are more susceptible to adverse effects due to the physiological changes of ageing and they run a potentially higher risk of falling than younger patients. Opioids are known to cause cognitive impairment, drowsiness and sedation together with an increased risk of fracture [6][7][8][9][10].…”

Non-hip and non-vertebral fractures: the neglected fracture sites

“…Falls, defined as falling from no greater than standing height, were classified differently for men and women due to differences in fall frequency between the sexes [11]. Men are less likely to fall, but are also less likely to report falls due to social desirability biases, reporting a fall is viewed as a loss of independence [12][13][14]. Thus, in women, falls were classified as Blow^or Bhigh,ŵ…”