Psychotropic drug use and the risk of hip fracture

Ray, W A; Griffin, Mary; Schaffner, W.; Baugh, David K.; Melton, L. Joseph

doi:10.1097/00004714-198708000-00029

Cited by 103 publications

(128 citation statements)

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“…Patients with mental disorders also tend to have reduced sensation and pain responsiveness, poor compliance with recommended postoperative health behaviors such as ambulating and self‐hygiene, and more frequent restraint use, all of which can contribute to their increased risk of developing decubitus ulcer during hospital stay. The threefold increase in postoperative hip fractures in these patients may be partially related to the undesirable sedative and autonomic effects of psychotropic drugs such as confusion, drowsiness, and ataxia (Ray et al 1987). In addition, some of these patients may exhibit abusive, aggressive, or other disruptive behaviors, which may lead to physical injuries and falls due to nurse aides' reluctance to provide necessary supportive care.…”

Section: Discussionmentioning

confidence: 99%

Adverse Hospital Events for Mentally Ill Patients Undergoing Coronary Artery Bypass Surgery

Glance

Cai

et al. 2008

Health Services Research

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Section: Discussionmentioning

confidence: 99%

Adverse Hospital Events for Mentally Ill Patients Undergoing Coronary Artery Bypass Surgery

Glance

Cai

et al. 2008

Health Services Research

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“…Participant characteristics were assessed at each participant's index date and were based on medical claims during the year preceding cohort entry. Covariates, listed in Table 1, were selected to control for many of the potential confounders identified in the literature 14,15,20–28,32–41 …”

Section: Methodsmentioning

confidence: 99%

Opioid Analgesics and the Risk of Fractures in Older Adults with Arthritis

Miller

Stürmer

Azrael

et al. 2011

Journal of the American Geriatrics Society

193

166

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Objectives To compare the risk of fracture associated with initiating opioids vs. non-steroidal anti-inflammatory drugs (NSAIDs), and the variation in risk by opioid dose, duration of action, and duration of use. Design Retrospective Cohort Study. Setting Enrollees in two statewide pharmaceutical benefit programs for persons aged 65 and older. Participants 12,436 initiators of opioids and 4,874 initiators of NSAIDs began treatment between 1/1/1999 and 12/31/2006. The mean age at initiation of analgesia was 81 years, 85% were female, and all had arthritis. Measurements Cox proportional hazard models, adjusted for several potential confounders, quantified fracture risk. Study outcomes were fractures of the hip, humerus/ulna, or wrist, identified by a combination of diagnosis (CD-9CM codes) and procedure (CPT codes). Results There were 587 fracture events among the patients initiating opioids (120 fractures per 1,000 person-years) and 38 fracture events among patients initiating NSAIDs (25 fractures per 1,000 person-years), hazard ratio [HR], 4.9 [95% CI, 3.5 to 6.9]. Fracture risk increased with opioid dose. Risk was higher for short-acting opioids (HR, 5.1, [CI, 3.7 to 7.1]) than for long-acting opioids (HR, 2.6, [CI, 1.5 to 4.4]), even among patients taking equianalgesic doses, with differential fracture risk apparent for the first two weeks after starting opioids, but not thereafter. Conclusion Older patients with arthritis who initiate therapy with opioids are more likely to suffer a fracture, compared with patients who initiate NSAIDs. For the first two weeks after initiating opioid therapy, but not thereafter, short-acting opioids are associated with a higher risk of fracture than are long-acting opioids.

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“…Falls and hip fractures have excited most attention. In the elderly the incidence of hip fractures may be increased by 50% or more, particularly when other medication such as antihypertensives and antidepressants are co‐prescribed .…”

Section: Adverse Effectsmentioning

confidence: 99%

Benzodiazepine harm: how can it be reduced?

Lader

2014

Brit J Clinical Pharma

269

191

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The benzodiazepines (BZDs) are anxiolytics, hypnotics, anticonvulsants, muscle‐relaxants and induce anaesthesia. Adverse effects comprise sedation subjectively and cognitive and psychomotor impairment objectively. Complex skills such as driving can be compromised. Paradoxical excitement can have forensic implications. Long term use beyond the licensed durations is common but both efficacy and adverse effects associated with this have been poorly documented. Withdrawal and dependence have excited particular concern, and even polemic. Perhaps a third of long term (beyond 6 months) users experience symptoms and signs on attempting to withdraw – anxiety, insomnia, muscle spasms and tension and perceptual hypersensitivity. Uncommonly, fits or a psychosis may supervene. The patterns following withdrawal vary widely. The usual method of withdrawal is slow tapering but it may not obviate the problems completely. BZDs are also drugs of abuse either on their own or in conjunction with opioids and stimulants. Claims have been made that the use of BZDs is associated with increased mortality. This is a concern in view of the widespread usage of these drugs, particularly in the elderly. All of these factors impinge on the risk : benefit ratio and the severity of the indications. Harm reduction should focus on choice of alternative treatments both psychological and pharmacological. Guidelines emphasise that BZDs are not drugs of first choice and should only be used short term. Schedules are available to educate about methods of withdrawal in current users, emphasising the slow rate of taper. General principles of harm minimization in the addiction field are appropriate to BZD abuse.

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Psychotropic drug use and the risk of hip fracture

Cited by 103 publications

References 0 publications

Adverse Hospital Events for Mentally Ill Patients Undergoing Coronary Artery Bypass Surgery

Adverse Hospital Events for Mentally Ill Patients Undergoing Coronary Artery Bypass Surgery

Opioid Analgesics and the Risk of Fractures in Older Adults with Arthritis

Benzodiazepine harm: how can it be reduced?

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