Reduce Fracture Risk by Reviewing Medications!

A team of researchers from The Dartmouth Institute for Health Policy and Clinical Practice and the Boston University School of Public Health recently took a look at older adults who have had a fragility fracture and the medication they were taking. “Is it possible to reduce these patients’ exposure to drugs associated with fracture risk, ” asked lead author Jeffrey Munson, M.D., MSCE, assistant professor at The Dartmouth Institute, and his colleagues.

As indicated in the August 22, 2016 news release, “The researchers analyzed data from a sample of 168, 133 Medicare beneficiaries (84% of whom were women with an average age of 80) who experienced a fracture of the hip, shoulder or wrist (the most common type of fragility fractures). The researcher team identified 21 drug classes that have been associated with increased fracture risk. After examining them as a single group, they then subdivided them into three groups: those drugs thought to increase fracture risk by increasing the risk of falls, those that decrease bone density, and those in which the mechanism which caused greater fracture risk was unclear. Medicare Part D retail pharmacy claims were used to measure fills for prescriptions associated with increased fracture risk both before and after the fracture occurred.”

“The use of drugs that can contribute to elevated fracture risk was common among the group we studied, ” said lead author Jeffrey Munson, M.D., MSCE, assistant professor at The Dartmouth Institute. “To add to that, we did not see a consistent reduction in the use of these drugs after the fracture event. So that allows for the strong possibility we may be able to prevent at least some of these secondary fragility fractures through better management of high-risk drugs around the time of the first fracture.”

Dr. Munson told OTW, “This work is part of a larger initiative to study ways we can decrease the risk of second fractures. We know there are drugs that have been shown to increase the risk of fracture. We designed this study to understand whether physicians treating patients who have suffered a fracture take the opportunity to discontinue these medications.

“We found that the same number of patients are using high-risk medications before and after a fracture. This suggests physicians are missing an opportunity to discontinue at least some of the medications whose risks of a second fracture may outweigh their benefits. We also saw that some patients are leaving the hospital after a fracture with new medications that increase their risk of fracture. It is important for all physicians who treat patients with a fracture to review medication lists at the time of a fracture and at the time of discharge to be sure we aren’t exposing patients to unnecessary risk.

“Hopefully this will raise awareness of prescription medications as a modifiable risk factor that contributes to potentially avoidable second fractures. Ideally this work will also lead to the development of robust medication review processes for this high-risk population.”