Patterns of Prescription Drug Use Before and After Fragility Fracture

Impact of prescription drugs on second fragility fractures among US Medicare patients

“…3,29 Among this group, 7,174 (5.2%) experienced a subsequent fracture in the 12 months following their index event. Table 2 shows the baseline characteristics of the total cohort.…”

“…Complete details of cohort selection and the database used for this study have been previously published. 3,29 Fractures were identified using a combination of ICD-9 codes, codes for an appropriate radiology examination, and codes indicating treatment (surgical procedure, immobilization or fixation.) Beneficiaries had to be enrolled in Medicare Parts A and B for at least 12 months and in Part D for 4 months prior to the index fracture and for the duration of follow up.…”

Potentially Inappropriate Medications and the Time to Full Functional Recovery After Hip Fracture

“…The frequency (51%) of PIM use in this sample of patients with hip fracture corresponds with previously reported PIM rates in the United States in older hospitalized patients (58.4%;[19]) and older community populations (42.6%; [20]). Our cohort had more sedative-hypnotic use, but less antidepressant use than a recent cohort of community-dwelling Medicare beneficiaries experiencing a fragility fracture [21]. …”

“…Unfortunately, to date there is little evidence that interventions to reduce PIM prescribing improve functional outcomes [30]. The challenge of effecting change in the prescribing of inappropriate medication was highlighted by a recent study that found that the prevalence of falls-promoting medications does not change post-fracture, with the small number of medication discontinuations balanced by the initiation of falls-promoting medication [21]. …”

“…at the end of the patient’s hospitalization for hip fracture. While we don’t know whether patients continued to be prescribed these medications in the 12 months post-hip fracture, previous studies have found that hospitalization tends to increase the prevalence of medications classed as PIM rather than decrease them [11, 21, 31] and PIM are rarely stopped after a fracture [21]. Studies designed to systematically reduce the use of PIM during hospitalization have shown that intensive intervention is required to effect even a small change in prevalence of PIM use [32].…”