Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: I. Cardiovascular Drugs

Vries, Max de; Daams, Joost G.; Glind, Esther M.M. van de; Masud, Tahir; Velde, Nathalie van der; Blain, Hubert; Bousquet, Jean; Bucht, Gösta; Caballero-Mora, Maria Angeles; Cammen, Tischa van der; Eklund, Patrik; Emmelot-Vonk, Mariëlle H.; Gustafson, Yngve; Hartikainen, Sirpa; Kenny, Rose Anne; Laflamme, Lucie; Landi, Francesco; O’Byrne-Maguire, Irene; Petrovic, Mirko; Rodriguez, Leocadio; Seppälä, Lotta J.; Svensson, Olle; Szczerbińska, Katarzyna; Thaler, H

doi:10.1016/j.jamda.2017.12.013

Cited by 214 publications

(217 citation statements)

References 23 publications

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“…(48) For this reason, asking patients about their history of falls should routinely be part of caring for patients with osteoporosis. (50)(51)(52) Fall risk may vary with the particular agent, however; thus, short-acting benzodiazepines and selective serotonin reuptake inhibitors may be safer in terms of fall risk than other drugs within their categories, (51) and the selectivity of beta-blockers may be a relevant factor. These include loop diuretics, antipsychotics, antidepressants, benzodiazepines, antiepileptics, and opioids.…”

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

“…(21,48,49) Particular medication classes associated with higher chance of falling are often referred to as fall-risk-increasing drugs (FRIDs). (50) Pharmacists can be helpful in reviewing FRID use Recommendation 1: Communicate three simple messages to people aged 65 years or older with a hip or vertebral fracture (as well as to their family/caregivers) consistently throughout the fracture care and healing process: (50)(51)(52) Fall risk may vary with the particular agent, however; thus, short-acting benzodiazepines and selective serotonin reuptake inhibitors may be safer in terms of fall risk than other drugs within their categories, (51) and the selectivity of beta-blockers may be a relevant factor.…”

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

“…These include loop diuretics, antipsychotics, antidepressants, benzodiazepines, antiepileptics, and opioids. (50)(51)(52) Fall risk may vary with the particular agent, however; thus, short-acting benzodiazepines and selective serotonin reuptake inhibitors may be safer in terms of fall risk than other drugs within their categories, (51) and the selectivity of beta-blockers may be a relevant factor. (50) Pharmacists can be helpful in reviewing FRID use Recommendation 1: Communicate three simple messages to people aged 65 years or older with a hip or vertebral fracture (as well as to their family/caregivers) consistently throughout the fracture care and healing process:…”

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

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Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

167

111

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Osteoporosis‐related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first‐line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post‐fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). © 2019 American Society for Bone and Mineral Research.

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Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

See 1 more Smart Citation

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

167

111

View full text Add to dashboard Cite

show abstract

“…Moreover, consistent associations with falls were reported for loop diuretics, antiepileptics, opioids, and polypharmacy (four or more medications) [16, 17]. Digitalis, non-selective beta-blocking agents, antiarrhythmics, diuretics in general, antihypertensives, anticholinergics, non-steroidal anti-inflammatory drugs, analgesics, laxatives, long-term proton pump inhibitors, and antiplatelets are also possible FRIDs [16, 17]. These high-risk medications are widely prescribed for older people.…”

Section: Prevention Of Medication-related Fallsmentioning

confidence: 69%

“…The recent systematic reviews and meta-analyses by the EuGMS Task and Finish group on FRIDs confirmed the association between psychotropics (antidepressants [selective serotonin reuptake inhibitors, tricyclic antidepressants], antipsychotics, benzodiazepines) and fall risk [15]. Moreover, consistent associations with falls were reported for loop diuretics, antiepileptics, opioids, and polypharmacy (four or more medications) [16, 17]. Digitalis, non-selective beta-blocking agents, antiarrhythmics, diuretics in general, antihypertensives, anticholinergics, non-steroidal anti-inflammatory drugs, analgesics, laxatives, long-term proton pump inhibitors, and antiplatelets are also possible FRIDs [16, 17].…”

Section: Prevention Of Medication-related Fallsmentioning

confidence: 92%

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research

et al. 2019

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Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

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Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults

Colón-Emeric,

McDermott,

Lee

et al. 2024

JAMA

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ImportanceFalls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, and health care expenditures.ObservationsFalls result from age-related physiologic changes compounded by multiple intrinsic and extrinsic risk factors. Major modifiable risk factors among community-dwelling older adults include gait and balance disorders, orthostatic hypotension, sensory impairment, medications, and environmental hazards. Guidelines recommend that individuals who report a fall in the prior year, have concerns about falling, or have gait speed less than 0.8 to 1 m/s should receive fall prevention interventions. In a meta-analysis of 59 randomized clinical trials (RCTs) in average-risk to high-risk populations, exercise interventions to reduce falls were associated with 655 falls per 1000 patient-years in intervention groups vs 850 falls per 1000 patient-years in nonexercise control groups (rate ratio [RR] for falls, 0.77; 95% CI, 0.71-0.83; risk ratio for number of people who fall, 0.85; 95% CI, 0.81-0.89; risk difference, 7.2%; 95% CI, 5.2%-9.1%), with most trials assessing balance and functional exercises. In a meta-analysis of 43 RCTs of interventions that systematically assessed and addressed multiple risk factors among individuals at high risk, multifactorial interventions were associated with 1784 falls per 1000 patient-years in intervention groups vs 2317 falls per 1000 patient-years in control groups (RR, 0.77; 95% CI, 0.67-0.87) without a significant difference in the number of individuals who fell. Other interventions associated with decreased falls in meta-analysis of RCTs and quasi-randomized trials include surgery to remove cataracts (8 studies with 1834 patients; risk ratio [RR], 0.68; 95% CI, 0.48-0.96), multicomponent podiatry interventions (3 studies with 1358 patients; RR, 0.77; 95% CI, 0.61-0.99), and environmental modifications for individuals at high risk (12 studies with 5293 patients; RR, 0.74; 95% CI, 0.61-0.91). Meta-analysis of RCTs of programs to stop medications associated with falls have not found a significant reduction, although deprescribing is a component of many successful multifactorial interventions.Conclusions and RelevanceMore than 25% of older adults fall each year, and falls are the leading cause of injury-related death in persons aged 65 years or older. Functional exercises to improve leg strength and balance are recommended for fall prevention in average-risk to high-risk populations. Multifactorial risk reduction based on a systematic clinical assessment for modifiable risk factors may reduce fall rates among those at high risk.

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Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: I. Cardiovascular Drugs

Cited by 214 publications

References 23 publications

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research

Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults

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