Polypharmacy Correlates With Increased Risk for Hip Fracture in the Elderly

Abstract

Few studies have addressed the association between polypharmacy and hip fracture using population data. We conducted a population-based case-control study to investigate whether polypharmacy increases the risk for hip fracture in the elderly. We used insurance claims data from the Taiwan Bureau of National Health Insurance, a universal insurance program with a coverage rate of more than 98% of the population in Taiwan. We identified 2328 elderly patients with newly diagnosed hip fracture during the period 2005-2007. We randomly selected 9312 individuals without hip fracture to serve as the control group. Patient characteristics, drugs prescribed by physicians, and all types of hip fracture were ascertained. The odds ratio (OR) of hip fracture in association with the number of medications used per day in previous years was assessed.We found that patients were older than controls, predominantly female, and more likely to use 5 or more drugs (22.2% vs. 9.3%, p < 0.0001). The OR of hip fracture increased with the number of medications used per day and with age. Multivariate logistic regression analysis revealed that the overall OR for patients using 10 or more drugs was 8.42 (95% confidence interval [CI], 4.73-15.0) compared with patients who used 0-1 drug per day. However, age-specific analysis revealed that the risk for hip fracture was 23 times greater for patients aged > or = 85 years who used 10 or more drugs than for those aged 65-74 years who used 0-1 drug after controlling for covariates (OR, 23.0; 95% CI, 3.77-140).We conclude that the risk of hip fracture in older people increases with the number of medications used, especially in women. Age interacts with the daily medications for the risk of hip fracture.

Periprosthetic Fractures Associated with Primary Total Shoulder Arthroplasty and Primary Humeral Head Replacement

“…We found that increasing comorbidity was associated with an increased risk of postoperative humeral shaft fracture after total shoulder arthroplasty and humeral head replacement. This finding is not surprising since higher comorbidity indicates more frailty and use of multiple pharmaceutical agents, both of which may be associated with a higher risk of falls and fractures [20][21][22][23] . A small sample size prevented us from examining individual comorbidities (diabetes, heart disease, etc.)…”

Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients

“…36 Multivariate logistic regression analysis revealed that the overall OR of falling among patients using ten or more drugs was 8.42 (95% CI 4.73-15.0) compared with patients who used 0-1 drug per day. 37 Another study also showed particular risk for falling (OR 6.1) in patients taking 10+ drugs. 38 Patients who are taking many different types of medications are high-risk groups, where increased monitoring or tailored drug regimens is necessary.…”

Deprescribing in the Last Year of Life

“…35 Polypharmacy has been associated with falls, hip fractures, hospitalisations and death. [36][37][38][39] Other burdens of polypharmacy include financial costs, practicalities of taking multiple doses and an increase in the possibility of non-adherence to prescribed medicines. Some of these burdens may be partly due to wellintentioned efforts to follow established evidence.…”