Study looks at ways to reduce prescription drugs linked to fracture risk among older adults

Fragility fractures -- those that occur at standing height -- are a significant source of sickness and death among the elderly population in the United States. They are also associated with annual direct costs of over $16 billion. As the U.S. population ages, there is an urgent need (and real opportunity) to identity individuals at risk for fracture and to find ways to reduce their occurrence.

In pursuit of this goal, a team of researchers from The Dartmouth Institute for Health Policy and Clinical Practice and the Boston University School of Public Health recently looked at whether there was an opportunity to reduce exposure to prescription drugs associated with fracture risk among one high-risk group --older adults who have already experienced a first fragility fracture. Previous research has shown that not only are such patients at a significantly increased risk of experiencing a second fracture, but that the risk is greatest in the first six months after the first fracture.

In the study, published online by JAMA Internal Medicine, the researchers analyzed data from a sample of 168,133 Medicare beneficiaries (84% of whom were women with an average age of 80) who experienced a fracture of the hip, shoulder of wrist (the most common type of fragility fractures). The researcher team identified 21 drug classes that have been associated with increased fracture risk. After examining them as a single group, they then subdivided them into three groups: those drugs thought to increase fracture risk by increasing the risk of falls, those that decrease bone density, and those in which the mechanism which caused greater fracture risk was unclear. Medicare Part D retail pharmacy claims were used to measure fills for prescriptions associated with increased fracture risk both before and after the fracture occurred. Among their findings after analysis:

• More than three-quarters of the patients in the study were exposed to at least one non-opiate drug associated with an increased fracture risk in the four months before their fracture.
• About 7 percent of patients discontinued these drugs after their fracture but that decrease was offset by new users so the total proportion exposed to high risk drugs did not change.

"The use of drugs that can contribute to elevated fracture risk was common among the group we studied," said lead author Jeffrey Munson, MD, MSCE, assistant professor at The Dartmouth Institute. "To add to that, we did not see a consistent reduction in the use of these drugs after the fracture event. So that allows for the strong possibility we may be able to prevent at least some of these secondary fragility fractures through better management of high-risk drugs around the time of the first fracture."

The study's authors noted that additional research was needed to determine the possible benefits of modifying post-fracture drug exposure in this high-risk population.