Is use of fall risk-increasing drugs in an elderly population associated with an increased risk of hip fracture, after adjustment for multimorbidity level: a cohort study

BMC Geriatrics

Anders Halling²  Lars Borgquist¹  Patrik Midlöv³  Karin Ranstad³  Kristine Thorell³ 

[1] Department of Medical and Health Sciences, General Practice, Linköping University, SE-581 83 Linköping, Sweden;Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9a, DK-5000 Odense C, Denmark;Department of Clinical Sciences in Malmö, General Practice/Family Medicine, Lund University, SE-205 02 Malmö, Sweden

关键词: Sweden;    Medication review;    Elderly;    Fall risk-increasing drugs;    Multimorbidity level;    Hip fracture;   

Others  :  1089808
DOI  :  10.1186/1471-2318-14-131

 received in 2014-06-27, accepted in 2014-11-27,  发布年份 2014

【 摘 要 】

Background

Risk factors for hip fracture are well studied because of the negative impact on patients and the community, with mortality in the first year being almost 30% in the elderly. Age, gender and fall risk-increasing drugs, identified by the National Board of Health and Welfare in Sweden, are well known risk factors for hip fracture, but how multimorbidity level affects the risk of hip fracture during use of fall risk-increasing drugs is to our knowledge not as well studied. This study explored the relationship between use of fall risk-increasing drugs in combination with multimorbidity level and risk of hip fracture in an elderly population.

Methods

Data were from Östergötland County, Sweden, and comprised the total population in the county aged 75 years and older during 2006. The odds ratio (OR) for hip fracture during use of fall risk-increasing drugs was calculated by multivariate logistic regression, adjusted for age, gender and individual multimorbidity level. Multimorbidity level was estimated with the Johns Hopkins ACG Case-Mix System and grouped into six Resource Utilization Bands (RUBs 0–5).

Results

2.07% of the study population (N = 38,407) had a hip fracture during 2007. Patients using opioids (OR 1.56, 95% CI 1.34-1.82), dopaminergic agents (OR 1.78, 95% CI 1.24-2.55), anxiolytics (OR 1.31, 95% CI 1.11-1.54), antidepressants (OR 1.66, 95% CI 1.42-1.95) or hypnotics/sedatives (OR 1.31, 95% CI 1.13-1.52) had increased ORs for hip fracture after adjustment for age, gender and multimorbidity level. Vasodilators used in cardiac diseases, antihypertensive agents, diuretics, beta-blocking agents, calcium channel blockers and renin-angiotensin system inhibitors were not associated with an increased OR for hip fracture after adjustment for age, gender and multimorbidity level.

Conclusions

Use of fall risk-increasing drugs such as opioids, dopaminergic agents, anxiolytics, antidepressants and hypnotics/sedatives increases the risk of hip fracture after adjustment for age, gender and multimorbidity level. Fall risk-increasing drugs, high age, female gender and multimorbidity level, can be used to identify high-risk patients who could benefit from a medication review to reduce the risk of hip fracture.

【 授权许可】

   
2014 Thorell et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Kanis JA, Johnell O, Oden A, Sernbo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B: Long-Term Risk of Osteoporotic Fracture in Malmö. Osteoporos Int 2000, 11(8):669-674.
• [2]Zethraeus N, Stromberg L, Jönsson B, Svensson O, Ohlen G: The cost of a hip fracture. Estimates for 1,709 patients in Sweden. Acta Orthop Scand 1997, 68(1):13-17.
• [3]Agusti A, Pages E, Cuxart A, Ballarin E, Vidal X, Teixidor J, Tomas J, Villar MM, Laporte JR: Exposure to medicines among patients admitted for hip fracture and the case-fatality rate at 1 year: a longitudinal study. Eur J Clin Pharmacol 2012, 68(11):1525-1531.
• [4]Evans JG: Drugs and falls in later life. Lancet 2003, 361(9356):448.
• [5]Formiga F, Navarro M, Duaso E, Chivite D, Ruiz D, Perez-Castejon JM, Lopez-Soto A, Pujol R: Factors associated with hip fracture-related falls among patients with a history of recurrent falling. Bone 2008, 43(5):941-944.
• [6]Roche JJ, Wenn RT, Sahota O, Moran CG: Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 2005, 331(7529):1374.
• [7]Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, Wong C, Stheman-Bereen C: Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 2000, 58:396-399.
• [8]Banks E, Reeves GK, Beral V, Balkwill A, Liu B, Roddam A: Hip fracture incidence in relation to age, menopausal status, and age at menopause: prospective analysis. PLoS Med 2009, 6(11):e1000181.
• [9]Chen JS, Sambrook PN, Simpson JM, Cameron ID, Cumming RG, Seibel MJ, Lord SR, March LM: Risk factors for hip fracture among institutionalised older people. Age Ageing 2009, 38(4):429-434.
• [10]Marks R, Allegrante JP, Ronald MacKenzie C, Lane JM: Hip fractures among the elderly: causes, consequences and control. Ageing Res Rev 2003, 2(1):57-93.
• [11]Berry SD, Zhu Y, Choi H, Kiel DP, Zhang Y: Diuretic initiation and the acute risk of hip fracture. Osteoporos Int 2013, 24(2):689-695.
• [12]Butt DA, Mamdani M, Austin PC, Tu K, Gomes T, Glazier RH: The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch Intern Med 2012, 172(22):1739-1744.
• [13]Bowie MW, Slattum PW: Pharmacodynamics in older adults: a review. Am J Geriatr Pharmacother 2007, 5(3):263-303.
• [14]Mangoni AA, Jackson SHD: Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2004, 57(1):6-14.
• [15]Chen Y, Zhu LL, Zhou Q: Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients. Ther Clin Risk Manag 2014, 10:437-448.
• [16]Fastbom J, Schmidt I: Indikatorer för god läkemedelsterapi hos äldre. In The Swedish National Bord for Health and Welfare 2010. Swedish; [http://www.socialstyrelsen.se/publikationer2010/2010-6-29 webcite]
• [17]Landi F, Onder G, Cesari M, Barillaro C, Russo A, Bernabei R: Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study. J Gerontol A Biol Sci Med Sci 2005, 60(5):622-626.
• [18]Hanlon JT, Boudreau RM, Roumani YF, Newman AB, Ruby CM, Wright RM, Hilmer SN, Shorr RI, Bauer DC, Simonsick EM, Studenski SA: Number and dosage of central nervous system medications on recurrent falls in community elders: the Health, Aging and Body Composition study. J Gerontol A Biol Sci Med Sci 2009, 64(4):492-498.
• [19]Ensrud KE, Blackwell TL, Mangione CM, Bowman PJ, Whooley MA, Bauer DC, Schwartz AV, Hanlon JT, Nevitt MC: Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc 2002, 50(10):1629-1637.
• [20]Ensrud KE, Blackwell T, Mangione CM, Bowman PJ, Bauer DC, Schwartz A, Hanlon JT, Nevitt MC, Whooley MA: Central nervous system active medications and risk for fractures in older women. Arch Intern Med 2003, 163(8):949-957.
• [21]Leipzig RM, Cumming RG, Tinetti ME: Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs J Am Geriatr Soc 1999, 47(1):30-39.
• [22]Takkouche B, Montes-Martinez A, Gill SS, Etminan M: Psychotropic medications and the risk of fracture: a meta-analysis. Drug Saf 2007, 30(2):171-184.
• [23]Pierfitte C, Macouillard G, Thicoipe M, Chaslerie A, Pehourcq F, Aissou M, Martinez B, Lagnaoui R, Fourrier A, Begaud B, Dangoumau J, Moore N: Benzodiazepines and hip fractures in elderly people: case–control study. BMJ 2001, 322(7288):704-708.
• [24]Pacher P, Ungvari Z: Selective serotonin-reuptake inhibitor antidepressants increase the risk of falls and hip fractures in elderly people by inhibiting cardiovascular ion channels. Med Hypotheses 2001, 57(4):469-471.
• [25]Leipzig RM, Cumming RG, Tinetti ME: Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs J Am Geriatr Soc 1999, 47(1):40-50.
• [26]Solomon DH, Mogun H, Garneau K, Fischer MA: Risk of fractures in older adults using antihypertensive medications. J Bone Miner Res 2011, 26(7):1561-1567.
• [27]Wirehn AB, Ostgren CJ, Carstensen JM: Age and gender differences in the impact of diabetes on the prevalence of ischemic heart disease: a population-based register study. Diabetes Res Clin Pract 2008, 79(3):497-502.
• [28]WHO Collaborating Centre for Drug Statistics Methodology: Guidelines for ATC classification and DDD assignment 2014. [http://www.whocc.no/atc_ddd_publications/guidelines/ webcite]
• [29]Starfield B, Weiner J, Mumford L, Steinwachs D: Ambulatory care groups: a categorization of diagnoses for research and management. Health Serv Res 1991, 26(1):53-74.
• [30]Zielinski A, Kronogard M, Lenhoff H, Halling A: Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care. BMC Public Health 2009, 9:347. BioMed Central Full Text
• [31]Weiner JP, Starfield BH, Steinwachs DM, Mumford LM: Development and application of a population-oriented measure of ambulatory care case-mix. Med Care 1991, 29(5):452-472.
• [32]Orueta JF, Lopez-De-Munain J, Baez K, Aiarzaguena JM, Aranguren JI, Pedrero E: Application of the ambulatory care groups in the primary care of a European national health care system: does it work? Med Care 1999, 37(3):238-248.
• [33]Cumming RG, Le Couteur DG: Benzodiazepines and Risk of Hip Fractures in Older People. CNS Drugs 2003, 17(11):825-838.
• [34]Herings RM, Stricker BH, de Boer A, Bakker A, Sturmans F: Benzodiazepines and the risk of falling leading to femur fractures. Dosage more important than elimination half-life. Arch Intern Med 1995, 155(16):1801-1807.
• [35]Weiner DK, Hanlon JT, Studenski A: Effects of Central Nervous System Polypharmacy on Falls Liability in Community-Dwelling Elderly. Gerontology 1998, 44(4):217-221.
• [36]Lee JS, Kwok T, Leung PC, Woo J: Medical illnesses are more important than medications as risk factors of falls in older community dwellers? A cross-sectional study. Age Ageing 2006, 35(3):246-251.
• [37]Milos V, Bondesson A, Magnusson M, Jakobsson U, Westerlund T, Midlov P: Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC Geriatr 2014, 14:40. BioMed Central Full Text
• [38]Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM: Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. J Am Geriatr Soc 1999, 47(7):850-853.
• [39]Ziere G, Dieleman JP, Hofman A, Pols HA, van der Cammen TJ, Stricker BH: Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol 2006, 61(2):218-223.
• [40]Curran HV, Collins R, Fletcher S, Kee SC, Woods B, Iliffe S: Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life. Psychol Med 2003, 33(7):1223-1237.
• [41]Gould RL, Coulson MC, Patel N, Highton-Williamson E, Howard RJ: Interventions for reducing benzodiazepine use in older people: meta-analysis of randomised controlled trials. Br J Psychiatry 2014, 204(2):98-107.
• [42]Statistics Sweden [http://www.scb.se/sv_/Hitta-statistik/ webcite]
• [43]Carlsson L, Strender LE, Fridh G, Nilsson GH: Clinical categories of patients and encounter rates in primary health care - a three-year study in defined populations. BMC Public Health 2006, 6:35. BioMed Central Full Text
• [44]Hjerpe P, Merlo J, Ohlsson H, Bengtsson Bostrom K, Lindblad U: Validity of registration of ICD codes and prescriptions in a research database in Swedish primary care: a cross-sectional study in Skaraborg primary care database. BMC Med Inform Decis Mak 2010, 10:23. BioMed Central Full Text
• [45]Medical Products Agency: Medical Products Agencys work to counteracting illegal drugs. Uppsala; 2011.