Outpatient Medications and Hip Fractures in the US

Abstract

This is the first national Veterans Health Administration hip fracture hospitalisation study that temporally linked outpatient fall-related medications in hip-fracture patients with matched controls. We found that of veterans with hip-fracture hospitalisations, 70% were prescribed outpatient medications from selected major drug categories that may potentially increase fall risk. Moreover, over one-third of hip-fracture patients received concomitant prescriptions of drugs from multiple selected drug categories. Hip-fracture patients, compared with matched controls of acute MI and pneumonia, had the largest pronounced differences in prescribed medications in the antiepileptics, antidepressants, antipsychotics and antiparkinson's drug classes. Although a randomised clinical trial is the 'gold standard' for determining causation issues, exposing patients, particularly the elderly, to the potential risk of injurious falls would raise serious patient safety research approval issues. If the relationship between selected drugs and falls is indeed to some extent causative, future retrospective multivariate analyses could quantify the magnitude of these effects.

Depressive Symptoms, Bone Loss, and Fractures in Postmenopausal Women

“…In contrast to our findings, a number of case-control studies using automated data have reported increased risk of hip fracture with antidepressant use. [41][42][43][44][45][46] This study design can be more vulnerable to bias owing to unmeasured covariates. 47 One cohort study has also reported a 65% increase risk of hip fracture with antidepressant therapy.…”

Selective serotonin reuptake inhibitor treatment and risk of fractures: a meta-analysis of cohort and case–control studies

“…Antidepressants are one of the most commonly prescribed drugs in the Western world and have been reported to be associated with an increased risk of fractures [6][7][8][9][10][11][12][13][14][15][16]. Selective serotonin reuptake inhibitors (SSRIs) are recommended for first-line pharmacological management of depression because they are considered safer and better tolerated [17] than other types of antidepressants.…”

Late-life Anxiety Disorders: A Review

“…In trying to reverse the wide distribution of benzodiazepines among anxious older adults, several authors have warned against pharmacologic treatments of late-life anxiety in general because even the prescription of safer psychotropic drugs, such as selective serotonin reuptake inhibitors (SSRIs), may be problematic in older adults [42]. Recent studies indicate that SSRIs and tricyclic antidepressants may also induce a heightened risk of falls, fractures, and cognitive impairment [43]. On the other hand, a psychological intervention may not always be feasible or successful.…”