Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Impact of Prescription Drugs on Fragility Fractures

Osteoporos Int; 2018 Dec; Munson, et al

Discontinuing high-risk drugs after fracture was not generally protective against subsequent fractures, according to a recent study. Therefore, preventing the addition of new medications may result in greater improvements in post-fracture care. Researchers analyzed a cohort of 138,526 Medicare beneficiaries who returned to the community after a fragility fracture. Post-fracture drug use was defined using retail pharmacy fills. The risk of second fracture associated with individual drug classes was analyzed using Cox proportional hazard models. Data were further analyzed to determine whether there is a difference in risk between continuing previous therapy and initiating new therapy after fracture. They found:

  • Many drug classes previously identified as increasing fracture risk were not associated with increased fracture risk in this cohort.
  • Discontinuing therapy at the time of fracture was only beneficial for patients taking selective serotonin reuptake inhibitors; however, initiating therapy in previous non-users increased second fracture risk for 5 classes of drugs: selective serotonin reuptake inhibitors, tricyclic antidepressants, antipsychotics, proton pump inhibitors, and non-benzodiazepine hypnotics.
Citation:

Munson JC, Bynum JPW, Bell J-E, et al. Impact of prescription drugs on second fragility fractures among US Medicare patients. Osteoporos Int. 2018;29(12):2771–2779. doi:10.1007/s00198-018-4697-0.

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