Mapping the prescriptiome to fractures in men—a national analysis of prescription history and fracture risk

Abrahamsen, Bo; Brixen, Kim

doi:10.1007/s00198-008-0711-2

Cited by 35 publications

(19 citation statements)

References 72 publications

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“…18 When considering how to manage older adults with chronic non-cancer pain, these data should be juxtaposed against the unacceptable risks associated with many analgesics and invasive procedures that are frequently prescribed to treat these patients. 19–24 Further, data indicate that the “bio” part of biopsychosocial chronic pain conditions in older adults are themselves multifactorial, requiring time and skill to identify 25–26 and, therefore, to appropriately tailor treatment.…”

Section: Measuring Pain At the Patient Encountermentioning

confidence: 99%

Pain as the Fifth Vital Sign: Exposing the Vital Need for Pain Education

Morone

Weiner

2013

Clinical Therapeutics

231

162

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In clinical practice pain as the 5th vital sign has proven to be more complex to assess, evaluate, and manage than originally anticipated. It has also had some serious consequences which were never intended. Associated with the national push to adequately manage patients in pain has been a rise in prescription opioids as well as a rise in opioid related death. Guided by pain as the 5th vital sign mandates, patients report pain and expect their providers to respond. Many clinicians do not know what the appropriate response is because they lack adequate education in the approach, examination, and management of patients in pain. Pain education starting in medical school and through postgraduate training usually involves piecemeal incorporation of pain topics into existing curricula or clinical rotations, without devoted stand-alone class-time. The net effect has been a serious deficit in clinical skills for the evaluation and management of the patient in pain. When both patients and clinicians view pain as purely a sensory experience then management is necessarily limited to managing the sensation (and the increased prescription of pain medications). This is likely to result in a suboptimal patient response, especially when managing chronic pain. Pain evaluation and management is further complicated in the older adult who requires a different approach to take into account comorbidities, including dementia, and increased adverse consequences of prescription medications. Expanding pain education and training is critical to remedying these problems. Attention must move beyond the focus of pain as a 5th vital sign to a focus on education and training in the evaluation, examination, and management of the patient’s pain report.

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Section: Measuring Pain At the Patient Encountermentioning

confidence: 99%

Pain as the Fifth Vital Sign: Exposing the Vital Need for Pain Education

Morone

Weiner

2013

Clinical Therapeutics

231

162

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“…TCAs could be related to fracture because of their adverse effects such as sedation or cardiac dysrhythmias leading to falls, but they might not have any intrinsic effect on the bone 12. SSRIs have been gaining recognition for increasing the risk of fractures as reported in previous studies 13–23…”

Section: Introductionmentioning

confidence: 98%

Use of selective serotonin reuptake inhibitors and risk of fracture: A systematic review and meta-analysis

Eom

Lee

et al. 2012

Journal of Bone and Mineral Research

113

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Previous studies have reported inconsistent findings regarding the association between the use of selective serotonin reuptake inhibitors (SSRIs) and the risk of fracture. We identified relevant studies by searching three electronic databases (MEDLINE, EMBASE, and the Cochrane Library) from their inception to October 20, 2010. Two evaluators independently extracted data. Because of heterogeneity, we used random-effects meta-analysis to obtain pooled estimates of effect. We identified 12 studies: seven case-control studies and five cohort studies. A meta-analysis of these 12 observational studies showed that the overall risk of fracture was higher among people using SSRIs (adjusted odds ratio [OR] ¼ 1.69, 95% confidence interval [CI] 1.51-1.90, I 2 ¼ 89.9%). Subgroup analysis by adjusted number of key risk factors for osteoporotic fracture showed a greater increased fracture risk in those adjusted for fewer than four variables (adjusted OR ¼ 1.83, 95% CI 1.57-2.13, I 2 ¼ 88.0%) than those adjusted for four or more variables (adjusted OR ¼ 1.38, 95% CI 1.27-1.49, I 2 ¼ 46.1%). The pooled ORs anatomical site of fracture in the hip/femur, spine, and wrist/forearm were 2.06 (95% CI 1.84-2.30, I 2 ¼ 62.3%), 1.34 (95% CI 1.13-1.59, I 2 ¼ 48.5%), and 1.51 (95% CI 1.26-1.82, I 2 ¼ 76.6%), respectively. Subgroup analysis by exposure duration revealed that the strength of the association decreased with a longer window of SSRI administration before the index date. The risk of fracture was greater within 6 weeks before the index date (adjusted OR ¼ 3.83, 95% CI 1.96-7.49, I 2 ¼ 41.5%) than 6 weeks or more (adjusted OR ¼ 1.60, 95% CI 0.93-2.76, I 2 ¼ 63.1%). Fracture risk associated with SSRI use may have a significant clinical impact. Clinicians should carefully consider bone mineral density screening before prescribing SSRIs and proper management for high-risk populations. ß

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“…Cohort studies have linked type 2 diabetes (T2DM) [12], cardiovascular disease [13] and hypertension [14] with osteoporotic fractures in men [12], suggesting that these variables could prove useful in fracture prediction. Registerbased studies have identified several medications that were associated with fracture risk in men [15,16]. In addition to insights into the pathophysiology of male osteoporosis, the risk conferred by these variables could be translated into clinically useful predictor variables once confirmed in different populations.…”

Section: Introductionmentioning

confidence: 99%