Association of Receiving Multiple, Concurrent Fracture-Associated Drugs With Hip Fracture Risk

Emeny, Rebecca T.; Chang, Chiang‐Hua; Skinner, Jonathan; O’Malley, A. James; Smith, Jeremy; Chakraborti, Gouri; Rosen, Clifford J.; Morden, Nancy E.

doi:10.1001/jamanetworkopen.2019.15348

Cited by 23 publications

(33 citation statements)

References 87 publications

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“…e Drug interaction with impact on precipitant documented in Facts & Comparisons eAnswers. 27 We also identified signals for antidepressants with muscle relaxants-timely findings given substantial nationwide increases in chronic use of the latter. 47 (1.3).…”

Section: Table 1 (Continued)mentioning

confidence: 86%

“…Despite the well-established associations between antidepressants and injury, few studies have examined the role of antidepressant drug interactions. A notable exception includes investigations of antidepressants with benzodiazepines, [20][21][22][23][24][25][26][27][28][29] although prior work has been limited to injuries of specific anatomic sites and specific causes, and ignored the potential for intraclass variation. Our study yielded many expected results for antidepressant-benzodiazepine combinations, although some had modestly elevated adjusted RRs.…”

Section: Discussionmentioning

confidence: 99%

“…25 A cohort study of US Medicare beneficiaries reported hazard ratios (HRs) for hip fracture among female and male users of SSRI/SNRIs with (4.5 and 7.1) and without (2.3 and 3.0) benzodiazepines, respectively. 27 Other observational studies of falls, 24 hip fracture, 26,28 and motor vehicle crash 20 found no associations or did not examine benzodiazepine interaction effects separate from a heterogeneous group of psychoactive drugs. 21,30,31 Interactions between antidepressants and benzodiazepines are biologically plausible given additive or synergistic pharmacodynamic (e.g., CNS depression) and/or pharmacokinetic (e.g., hepatic metabolism) effects.…”

Section: Discussionmentioning

confidence: 99%

“…17 Further, the US National Highway Traffic Safety Administration considers the identification of antidepressant drug interactions as a critical countermeasure to prevent drugimpaired driving leading to injurious crashes. 18 Prior population-based studies of antidepressant drug interactions and injury have been largely limited to concomitant use with alcohol, 19,20 benzodiazepines, [20][21][22][23][24][25][26][27][28][29][30][31] opioids, 27,29 and/or anticholinergic drugs. 23,29 Although an initial focus on these CNSactive agents is intuitive, this leaves a critical knowledge gap.…”

Section: Articlementioning

confidence: 99%

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Population‐Based Signals of Antidepressant Drug Interactions Associated With Unintentional Traumatic Injury

Leonard

Brensinger

Acton

et al. 2021

Clin Pharma and Therapeutics

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Antidepressants are very widely used and associated with traumatic injury, yet little is known about their potential for harmful drug interactions. We aimed to identify potential drug interaction signals by assessing concomitant medications (precipitant drugs) taken with individual antidepressants (object drugs) that were associated with unintentional traumatic injury. We conducted pharmacoepidemiologic screening of 2000-2015 Optum Clinformatics data, identifying drug interaction signals by performing self-controlled case series studies for antidepressant + precipitant pairs and injury. We included persons aged 16-90 years codispensed an antidepressant and ≥ 1 precipitant drug(s), with an injury during antidepressant therapy. We classified antidepressant persondays as either precipitant-exposed or precipitant-unexposed. The outcome was an emergency department or inpatient discharge diagnosis for unintentional traumatic injury. We used conditional Poisson regression to calculate confounder adjusted rate ratios (RRs) and accounted for multiple estimation via semi-Bayes shrinkage. We identified 330,884 new users of antidepressants who experienced an injury. Among such persons, we studied concomitant use of 7,953 antidepressant + precipitant pairs. Two hundred fifty-six (3.2%) pairs were positively associated with injury and deemed potential drug interaction signals; 22 of these signals had adjusted RRs > 2.00. Adjusted RRs ranged from 1.06 (95% confidence interval: 1.00-1.12, P = 0.04) for citalopram + gabapentin to 3.06 (1.42-6.60) for nefazodone + levonorgestrel. Sixty-five (25.4%) signals are currently reported in a seminal drug interaction knowledgebase. We identified numerous new population-based signals of antidepressant drug interactions associated with unintentional traumatic injury. Future studies, intended to test hypotheses, should confirm or refute these potential interactions.

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Section: Table 1 (Continued)mentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Articlementioning

confidence: 99%

See 2 more Smart Citations

Population‐Based Signals of Antidepressant Drug Interactions Associated With Unintentional Traumatic Injury

Leonard

Brensinger

Acton

et al. 2021

Clin Pharma and Therapeutics

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“…The prevalence of suspected medication-related falls is about 41% [ 555 ] to 49% [ 556 ]. Increased risk of falls was documented in users of anxiolytics/hypnotics, opioids, sedatives, antihypertensives (especially alpha-blockers), antidepressants, antiparkinsonian medications, antiepileptics and antiarrhythmics [ 557 , 558 , 559 , 560 , 561 , 562 , 563 , 564 , 565 , 566 , 567 , 568 , 569 , 570 , 571 , 572 , 573 , 574 , 575 , 576 , 577 , 578 , 579 , 580 , 581 , 582 , 583 ]; polypharmacy is strongly associated with injurious falls and fractures [ 574 , 582 , 584 , 585 , 586 , 587 , 588 ].…”

Section: Hpi-associated Chronic Extra-gastroduodenal Diseases Medmentioning

confidence: 99%

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Fisher

Smith

2020

JCM

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Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world’s population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI–OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.

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Low-Value Care at the Actionable Level of Individual Health Systems

et al. 2021

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IMPORTANCE Low-value health care remains prevalent in the US despite decades of work to measure and reduce such care. Efforts have been only modestly effective in part because the measurement of low-value care has largely been restricted to the national or regional level, limiting actionability.OBJECTIVES To measure and report low-value care use across and within individual health systems and identify system characteristics associated with higher use using Medicare administrative data. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study of health system-attributed Medicare beneficiaries was conducted among 556 health systems in the Agency for Healthcare Research and Quality Compendium of US Health Systems and included system-attributed beneficiaries who were older than 65 years, continuously enrolled in Medicare Parts A and B for at least 12 months in 2016 or 2017, and eligible for specific low-value services. Statistical analysis was conducted from January 26 to July 15, 2021. MAIN OUTCOMES AND MEASURESUse of 41 individual low-value services and a composite measure of the 28 most common services among system-attributed beneficiaries, standardized to distance from the mean value. Measures were based on the Milliman MedInsight Health Waste Calculator and published claims-based definitions.RESULTS Across 556 health systems serving a total of 11 637 763 beneficiaries, the mean (SD) use of each of the 41 low-value services ranged from 0% (0.01%) to 28% (4%) of eligible beneficiaries. The most common low-value services were preoperative laboratory testing (mean [SD] rate, 28% [4%] of eligible beneficiaries), prostate-specific antigen testing in men older than 70 years (mean [SD] rate, 27% [8%]), and use of antipsychotic medications in patients with dementia (mean [SD] rate, 24% [8%]). In multivariable analysis, the health system characteristics associated with higher use of low-value care were smaller proportion of primary care physicians (adjusted composite score, 0.15 [95% CI, 0.04-0.26] for systems with less than the median percentage of primary care physicians vs −0.16 [95% CI, -0.27 to -0.05] for those with more than the median percentage of primary care physicians; P < .001), no major teaching hospital (adjusted composite, 0.10 [95% CI, -0.01 to 0.20] without a teaching hospital vs −0.18 [95% CI, -0.34 to -0.02] with a teaching hospital; P = .01), larger proportion of non-White patients (adjusted composite, 0.15 [95% CI, -0.02 to 0.32] for systems with >20% of non-White beneficiaries vs −0.06 [95% CI, -0.16 to 0.03] for systems with Յ20% of non-White beneficiaries; P = .04), headquartered in the South or West (adjusted composite, 0.28 [95% CI, 0.14-0.43] for the South and 0.22 [95% CI, 0.02-0.42] for the West compared with −0.09 [95% CI, -0.26 to 0.08] for the Northeast and −0.44 [95% CI, -0.60 to -0.28] for the Midwest; P < .001), and serving areas with more health care spending (adjusted composite, 0.23 [95% CI, 0.11-0.35] for areas above the median level of spending vs −0.24 [95% CI, -0.36 to -0....

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Association of Receiving Multiple, Concurrent Fracture-Associated Drugs With Hip Fracture Risk

Cited by 23 publications

References 87 publications

Population‐Based Signals of Antidepressant Drug Interactions Associated With Unintentional Traumatic Injury

Population‐Based Signals of Antidepressant Drug Interactions Associated With Unintentional Traumatic Injury

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Low-Value Care at the Actionable Level of Individual Health Systems

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