Polypharmacy related with increased risk of hip fracture in the older patients

Abstract

Background Polypharmacy and the use of a particular group of drugs including benzodiazepines, neuroleptics, antidepressants, antihypertensives, diuretics, acetylcholinesterase inhibitors and proton pump inhibitors have been associated with the risk of falls and subsequent hip fracture (HF). Purpose Assess the association between polypharmacy and the use of drugs related to falls and analyse the mortality in older patients with HF. Materials and methods This is a population-based retrospective case-control study. The case group consists of patients aged≥75 years admitted to a tertiary hospital with HF after accidental fall during the year 2010. 61 patients without HF of internal medicine service were randomised as the control group. To compare comorbidity between both groups Charlson index was used. SPSS was used to estimate update Bayesian OR and 95% credible intervals (CI). Results 61 patients were admitted with HF. The relationship in the control group was 1:1. Mean age 83.3±4.8 years (60.7% women) for the case group versus 81.97±4.04, p=0.12. The number of drugs consumed was 7.2±3.3 in older with HF versus 4.9±2.1, p<0.05. Statistically significant differences were founded (p<0.05) in: benzodiazepines (OR 3.87, CI 1.77 to 8.46); antidepressants (OR 3.26, CI 1.18 to 9.02) and diuretics (OR 2.58, CI 1.24 to 5.39). The 34.42% of patients with HF died before 1 year, compared to 9.8% in the control group (p <0.05, OR 5.7, 95% CI 2.1 to 15). Mean Charlson index was 4.16 for HF and 3.62 for control group (p=0.14). Conclusions The risk of HF in the older increases with the number of medications taken and the use of benzodiazepines, antidepressants and diuretics. The mortality in the older with HF is three times higher than the control group, which is consistent with published studies. These studies show death rate among 17–33% after the first year of suffering HF>.

Polypharmacy and risk of fractures in older adults: A systematic review

“…Among the 10 studies that presented comparisons, the number of medications, as well as the prevalence of polypharmacy, was generally higher among fracture cases than non‐cases 27,28,34,36–38,53,54 (median: 5 vs 4 medications 34 ; mean: 5.8 vs 5.3, 28 3 vs 2.5, 36 and 7.5 vs 5.6 medications 54 ; prevalence of polypharmacy ≥5 medications: 55% vs 43%, 27 55% vs 50%, 28 57% vs 50%, 34 20% vs 14%, 36 22% vs 9%, 37 75% vs 61%, 38 49% vs 64%, 40 and 78% vs 71% 53 ; prevalence of polypharmacy ≥10 medications: 17% vs 10%, 27 18% vs 15%, 28 18% vs 12%, 34 22% vs 25%, 35 1.6% vs 0.8%, 36 1.3% vs 0.2%, 37 and 46% vs 39% 53 ). Although the differences were not large, the pattern remained regardless of how medications were calculated or which data sources were used.…”

“…Sample size varied from 50 26 to 2,997,872 27 individuals (Table 1). Hip fractures was the most studied outcome ( n = 16 (17 articles) 26,28–43 ), followed by all bone fractures ( n = 12 27,44–54 ), upper limb fractures ( n = 2 55,56 ), and fragility fractures ( n = 1 57 ). In 13 studies, the association between polypharmacy and fractures was not the primary objective 29,32–34,39–42,47,51,54–56 .…”

“…Five out of six studies using the cumulative method had different medication counting periods, ranging from 30 days 34 to 12 months 27,35 . Of note, the calculation method was unclear for seven studies 31,33,38–40,46,50 . Secondly, polypharmacy (or medication categories) was defined in 11 different ways with nine different reference categories.…”

“…The analysis showed an increasing dose–response relationship between the number of medications and fracture risk (Figure 2), although CIs were sometimes large, indicating important statistical uncertainty 36–38 . Of the 16 studies that examined the association between polypharmacy and fractures using an explanatory approach and that provided association measures, nine showed a positive association 36–38,44,45,49,53,54,57 .…”

“…The analysis showed an increasing dose–response relationship between the number of medications and fracture risk (Figure 2), although CIs were sometimes large, indicating important statistical uncertainty 36–38 . Of the 16 studies that examined the association between polypharmacy and fractures using an explanatory approach and that provided association measures, nine showed a positive association 36–38,44,45,49,53,54,57 . For example, the use of ≥11 medications was associated with an increased risk of hip fracture in one study (OR = 9.0, 95% CI: 1.09–74.81), 38 whereas the use of ≥10 medications was associated with an increased risk of all bone fractures in another (OR = 2.46, 95% CI: 1.37–4.44) 49 .…”