Health Blog

Falls are undoubtedly the greatest threat to the health of older adults, as they represent the leading cause of non–fatal injuries responsible for hospital admissions and death in this age group. About one–third of adults over the age of 65 and one–half of adults over 85 will fall at least once each year, which leads to approximately 2.8 million ER visits, 800,000 hospitalizations, and 27,000 deaths annually. In addition, about 20–30% of falls cause moderate to severe injuries that have a significant impact on one’s functional mobility and independence, which makes them a top priority in healthcare.

Falls occur in older adults due to a combination of both nonmodifiable and modifiable risk factors. Nonmodifiable risk factors are those that one is unable to control or change, including their age, sex, race, having a history of prior falls, and having certain chronic conditions. Modifiable risk factors are those that can be altered, and there are many modifiable risk factors associated with falls, including one’s balance, muscle strength, mobility deficits, and the fear of falling. Another extremely important modifiable risk factor is medication usage, as certain medications and combinations of medications are known to increase the risk of falling.

With this in mind, a study was conducted to examine the relationship between certain prescription medications and the risk of sustaining a secondary fracture after an initial fracture. Investigators were also interested in whether having one fracture influences if doctors change their prescribing behaviors for drugs that either increase or decrease fracture risk.

To conduct the study, researchers used Medicare data to identify beneficiaries who were living in assisted living facilities and who survived a fracture of the hip, shoulder, or wrist over a span of four years. Researchers then devised a list of 21 drug classes that are associated with an increased risk for fractures—including benzodiazepines, antidepressants, and anti–Parkinson disease drugs—and analyzed the use of these drugs within 120 days of the fracture to determine if there was any connection between their use and suffering a fracture.

A total of 168,133 patients with a fracture met the necessary criteria and were included in the study, with the average age of these patients being 80 years. Of the included patients, 76% were exposed to at least one non–opiate drug associated with an increased risk of fracture in the 120 days prior to the date of the fracture, and this finding was consistent across all fracture types. More than half of these patients (55.7%) were taking at least one drug that increases fall risk prior to the index fracture while 42.2% were taking at least one drug that decreases bone density. After the initial fracture, there were only minimal changes in the proportion of patients who continued taking drugs associated with an increased fracture risk, and most patients continued to fill the same number of prescriptions for high–risk non–opiate drugs after their index fracture. Finally, the use of drugs that decrease fracture risk was low, with less than one–quarter of patients filling a prescription for a drug that increases bone density in the 120 days prior to their initial fracture.

These findings show that the use of drugs associated with an increased risk for fracture is common in Medicare beneficiaries, which means that these drugs can be considered a key modifiable risk factor for preventing fractures. In addition, suffering a fracture does not seem to consistently affect patients’ exposure to potentially risky drugs, as most continued to be prescribed these high–risk drugs in the aftermath of their initial fracture.

This study should serve as a wake–up call for healthcare providers who treat older patients to be extremely careful about what drugs they prescribe, especially if a patient experiences a fall–related fracture. Older adults and their caregivers should also be more cognizant of the potential risks associated with each drug individually and how they interact with other drugs by asking their prescribing physician before taking any new medications. We also strongly advise older patients who would like to reduce their risk for falls to consider seeing a physical therapist, who can help address other modifiable risk factors by improving their strength, balance, and mobility.