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Treatment with Fall-Risk-Increasing and Fracture-Preventing Drugs Before and After a Hip Fracture

An Observational Study

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Abstract

Background Hip fracture is a common diagnosis in the older population, with often serious consequences. Drug treatment may be of significance for both falls and fractures.

Objective To investigate drug treatment in older hip fracture patients, focusing on use of fall-risk-increasing and fracture-preventing drugs before and after the fracture.

Methods This was an observational study conducted in Sahlgrenska University Hospital, Gothenburg, Sweden. The participants were 100 consecutive hip fracture patients aged ≤65 years with a median age of 86 (range 66–97) years. Seventy-three patients were female, and 87 patients had at least one strong risk factor for a fracture. Four patients died during the hospital stay, and a further 18 died within 6 months after discharge. Treatment with fall-risk-increasing and fracture-preventing drugs at admission to hospital, at discharge and 6 months after the hip fracture was measured.

Results The numbers of patients treated with fall-risk-increasing drugs were 93 (93%), 96 (100%) and 73 (94%) at admission, discharge and 6-month follow-up, respectively. The median (range) number of such drugs was 3 (0–9), 4(1–10) and 3 (0–10), respectively. A total of 17 (17%), 32 (33%) and 29 (37%) patients were treated with fracture-preventing drugs, predominantly calcium plus vitamin D, at admission, discharge and 6-month follow-up, respectively. Five patients (5%) used bisphosphonates or selective estrogen receptor modulators at admission. No additional patients had these drugs prescribed during the hospital stay. At 6-month follow-up, four more patients were treated with bisphosphonates.

Conclusions Treatment with fall-risk-increasing drugs was extensive among older hip fracture patients both before and after the fracture. The proportion of patients with fracture-preventing drugs was low at admission and increased slightly during the follow-up period. Hence, drug treatment in older hip fracture patients can be improved regarding both fall-risk-increasing drugs and fracture-preventing drugs.

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References

  1. Johnell O, Gullberg B, Allander E, et al. The apparent incidence of hip fracture in Europe: a study of national register sources. MEDOS Study Group. Osteoporos Int 1992 Nov; 2(6): 298–302

    Article  PubMed  CAS  Google Scholar 

  2. Kanis JA, Johnell O, Oden A, et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 2000; 11(8): 669–74

    Article  PubMed  CAS  Google Scholar 

  3. Hasserius R, Johnell O, Nilsson BE, et al. Hip fracture patients have more vertebral deformities than subjects in population-based studies. Bone 2003 Feb; 32(2): 180–4

    Article  PubMed  CAS  Google Scholar 

  4. Colon-Emeric C, Kuchibhatla M, Pieper C, et al. The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies. Osteoporos Int 2003 Nov; 14(11): 879–83

    Article  PubMed  Google Scholar 

  5. Kanis JA, Oden A, Johnell O, et al. The components of excess mortality after hip fracture. Bone 2003 May; 32(5): 468–73

    Article  PubMed  CAS  Google Scholar 

  6. Sernbo I, Johnell O. Consequences of a hip fracture: a prospective study over 1 year. Osteoporos Int 1993 May; 3(3): 148–53

    Article  PubMed  CAS  Google Scholar 

  7. Meyer HE, Tverdal A, Selmer R. Weight variability, weight change and the incidence of hip fracture: a prospective study of 39,000 middle-aged Norwegians. Osteoporos Int 1998; 8(4): 373–8

    Article  PubMed  CAS  Google Scholar 

  8. Nguyen T, Sambrook P, Kelly P, et al. Prediction of osteoporotic fractures by postural instability and bone density. BMJ 1993 Oct 30; 307(6912): 1111–5

    Article  PubMed  CAS  Google Scholar 

  9. Kanis JA, Borgstrom F, De Laet C, et al. Assessment of fracture risk. Osteoporos Int 2005 Jun; 16(6): 581–9

    Article  PubMed  Google Scholar 

  10. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002 May 18; 359(9319): 1761–7

    Article  PubMed  Google Scholar 

  11. Gillespie LD, Gillespie WJ, Robertson MC, et al. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 2003; (4): CD000340

    Google Scholar 

  12. Speechley M, Tinetti M. Falls and injuries in frail and vigorous community elderly persons. J Am Geriatr Soc 1991 Jan; 39(1): 46–52

    PubMed  CAS  Google Scholar 

  13. Kallin K. Falls in older people in geriatric care settings. Umeå: Umeå University, 2004

    Google Scholar 

  14. Kallin K, Lundin-Olsson L, Jensen J, et al. Predisposing and precipitating factors for falls among older people in residential care. Public Health 2002 Sep; 116(5): 263–71

    PubMed  CAS  Google Scholar 

  15. Tangman S, Eriksson S, Gustafson Y, et al. Precipitating factors for falls among patients with dementia on a psychogeriatric ward. Int Psychogeriatr 2010 Feb; 2: 1–9

    Google Scholar 

  16. van der Velde N, Stricker BH, Pols HA, et al. Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study. Br J Clin Pharmacol 2007 Feb; 63(2): 232–7

    Article  PubMed  Google Scholar 

  17. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999 Jan; 47(1): 30–9

    PubMed  CAS  Google Scholar 

  18. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc 1999 Jan; 47(1): 40–50

    PubMed  CAS  Google Scholar 

  19. Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet 2002 Jun 1; 359(9321): 1929–36

    Article  PubMed  Google Scholar 

  20. Melton 3rd LJ. The prevalence of osteoporosis: gender and racial comparison. Calcif Tissue Int 2001 Oct; 69(4): 179–81

    Article  PubMed  CAS  Google Scholar 

  21. Johnell O, Kanis JA, Oden A, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res 2005 Jul; 20(7): 1185–94

    Article  PubMed  Google Scholar 

  22. Sowers MR, Clark MK, Jannausch ML, et al. Body size, estrogen use and thiazide diuretic use affect 5-year radial bone loss in postmenopausal women. Osteoporos Int 1993 Dec; 3(6): 314–21

    Article  PubMed  CAS  Google Scholar 

  23. Diem SJ, Blackwell TL, Stone KL, et al. Use of antidepressants and rates of hip bone loss in older women: the study of osteoporotic fractures. Arch Intern Med 2007 Jun 25; 167(12): 1240–5

    Article  PubMed  Google Scholar 

  24. Berthold HK, Unverdorben S, Zittermann A, et al. Age-dependent effects of atorvastatin on biochemical bone turnover markers: a randomized controlled trial in post-menopausal women. Osteoporos Int 2004 Jun; 15(6): 459–67

    Article  PubMed  CAS  Google Scholar 

  25. Panneman MJ, Lips P, Sen SS, et al. Undertreatment with anti-osteoporotic drugs after hospitalization for fracture. Osteoporos Int 2004 Feb; 15(2): 120–4

    Article  PubMed  Google Scholar 

  26. Kanis JA, on behalf of the World Health Organization Scientific Group (2007). Assessment of osteoporosis at the primary health-care level. Technical report. Sheffield: World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, 2007

    Google Scholar 

  27. Qaseem A, Snow V, Shekelle P, et al. Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2008 Sep 16; 149(6): 404–15

    PubMed  Google Scholar 

  28. Albertsson DM, Mellstrom D, Petersson C, et al. Validation of a 4-item score predicting hip fracture and mortality risk among elderly women. Ann Fam Med 2007 Jan-Feb; 5(1): 48–56

    Article  PubMed  Google Scholar 

  29. The Swedish Medical Products Agency. Treatment of osteoporosis: treatment guidelines. Information från Läkemedelsverket 2007; 18(4): 19–29

    Google Scholar 

  30. Campbell AJ, Robertson MC, Gardner MM, et al. Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. J Am Geriatr Soc 1999 Jul; 47(7): 850–3

    PubMed  CAS  Google Scholar 

  31. Lee JS, Kwok T, Leung PC, et al. Medical illnesses are more important than medications as risk factors of falls in older community dwellers? A cross-sectional study. Age Ageing 2006 May; 35(3): 246–51

    Article  PubMed  Google Scholar 

  32. Iyer S, Naganathan V, McLachlan AJ, et al. Medication withdrawal trials in people aged 65 years and older: a systematic review. Drugs Aging 2008; 25(12): 1021–31

    Article  PubMed  Google Scholar 

  33. Myers MG, Weingert ME, Fisher RH, et al. Unnecessary diuretic therapy in the elderly. Age Ageing 1982 Nov; 11(4): 213–21

    Article  PubMed  CAS  Google Scholar 

  34. Nelson MR, Reid CM, Krum H, et al. Predictors of normotension on withdrawal of antihypertensive drugs in elderly patients: prospective study in second Australian national blood pressure study cohort. BMJ 2002 Oct 12; 325(7368): 815–9

    Article  PubMed  Google Scholar 

  35. Curran HV, Collins R, Fletcher S, et al. Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life. Psychol Med 2003 Oct; 33(7): 1223–37

    Article  PubMed  CAS  Google Scholar 

  36. Lakatos P. Thyroid hormones: beneficial or deleterious for bone? Calcif Tissue Int 2003 Sep; 73(3): 205–9

    Article  PubMed  CAS  Google Scholar 

  37. Barrett-Connor E, Weiss TW, McHorney CA, et al. Predictors of falls among postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int 2009 May; 20(5): 715–22

    Article  PubMed  CAS  Google Scholar 

  38. Kallin K, Gustafson Y, Sandman PO, et al. Drugs and falls in older people in geriatric care settings. Aging Clin Exp Res 2004 Aug; 16(4): 270–6

    PubMed  Google Scholar 

  39. Boonen S, Dejaeger E, Vanderschueren D, et al. Osteoporosis and osteoporotic fracture occurrence and prevention in the elderly: a geriatric perspective. Best Pract Res Clin Endocrinol Metab 2008 Oct; 22(5): 765–85

    Article  PubMed  Google Scholar 

  40. Ensrud KE, Black DM, Palermo L, et al. Treatment with alendronate prevents fractures in women at highest risk: results from the Fracture Intervention Trial. Arch Intern Med 1997 Dec 8–22; 157(22): 2617–24

    Article  PubMed  CAS  Google Scholar 

  41. Boonen S, McClung MR, Eastell R, et al. Safety and efficacy of risedronate in reducing fracture risk in osteoporotic women aged 80 and older: implications for the use of anti-resorptive agents in the old and oldest old. J Am Geriatr Soc 2004 Nov; 52(11): 1832–9

    Article  PubMed  Google Scholar 

  42. Tosi LL, Lane JM. Osteoporosis prevention and the orthopaedic surgeon: when fracture care is not enough. J Bone Joint Surg Am 1998 Nov; 80(11): 1567–9

    PubMed  CAS  Google Scholar 

  43. Rabenda V, Vanoverloop J, Fabri V, et al. Low incidence of anti-osteoporosis treatment after hip fracture. J Bone Joint Surg Am 2008 Oct; 90(10): 2142–8

    Article  PubMed  Google Scholar 

  44. Juby AG, De Geus-Wenceslau CM. Evaluation of osteoporosis treatment in seniors after hip fracture. Osteoporos Int 2002 Mar; 13(3): 205–10

    Article  PubMed  CAS  Google Scholar 

  45. Lyles KW, Colon-Emeric CS, Magaziner JS, et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 2007 Nov 1; 357(18): 1799–809

    Article  PubMed  CAS  Google Scholar 

  46. Mancia G, De Backer G, Dominiczak A, et al. Guidelines for the Management of Arterial Hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007 Jun; 25(6): 1105–87

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This work was supported by the Swedish National Board of Health and Welfare. The funding source did not influence the design or conduct of the study; the collection, management, analysis or interpretation of the data; or the preparation, review or approval of the manuscript. The authors have no conflicts of interest that are directly relevant to the content of this study. No persons other than the authors have made substantial contributions to this work.

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Authors and Affiliations

  1. Department of Geriatrics, Sahlgrenska University Hospital, SE-431 80, Mölndal, Sweden

    Christina Sjöberg & Dan Mellström

  2. Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden

    Lina Bladh, Claes Ohlsson & Susanna M. Wallerstedt

  3. Department of Medicine, Sahlgrenska University Hospital, Mölndal, Sweden

    Lars Klintberg

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  1. Christina Sjöberg
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  2. Lina Bladh
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  4. Dan Mellström
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  6. Susanna M. Wallerstedt
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Correspondence to Christina Sjöberg.

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Sjöberg, C., Bladh, L., Klintberg, L. et al. Treatment with Fall-Risk-Increasing and Fracture-Preventing Drugs Before and After a Hip Fracture. Drugs Aging 27, 653–661 (2010). https://doi.org/10.2165/11538200-000000000-00000

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