After a fracture, it’s time to rethink medications

After a fracture, it’s time to rethink medications

With half of all women and a quarter of all men over fifty expected to suffer a fracture in the years ahead, the number of such injuries exceeds the incidence of heart attack, stroke, and breast cancer combined.

By discouraging the use of medications that can cause dizziness or loss of balance and prescribing medications known to prevent bone loss, clinicians can help patients lower their risk of falls and fractures.

In a commentary published in JAMA Internal Medicine, researchers underscore the importance of reviewing patients’ prescription medications in the wake of a fracture.

Appearing alongside previous research that finds few changes are made to patients’ prescription medications in the 4 months following a fracture, the commentary is a call for clinicians to coordinate care among orthopedics, rehabilitation services and primary care to reevaluate patients’ medication use.

More than 20 percent of older people who break a hip die within a year — a death rate two- to four-times higher than that among uninjured people the same age and sex.

Other complications of broken bones among the elderly include pain, depression, infection, functional decline and subsequent fractures.

Researchers suggest a two-prong approach for clinicians considering patient medications after a fall or fracture.

First, clinicians should consider reducing or discontinuing the use of drugs linked to increased risk of falls or fractures — especially psychotropic medications such as sleep aids, sedatives and antidepressants that can cause dizziness or loss of balance.

Second, clinicians should prioritize prescribing drugs known to prevent the likelihood of fractures among this high-risk group, the authors wrote.

The National Osteoporosis Foundation recommends osteoporosis medication for all adults over 50 who have fractured a hip.

Researchers suggest that multiple care teams working across various medical settings can make it unclear which provider should conduct this post-fracture medication review.

Primary care physicians are generally not involved in the immediate care of fractures, the authors wrote, but orthopedic specialists may not have the long-term relationship necessary to help make risk/benefit decisions about certain sleep or mood medications.

“Most clinicians wouldn’t dispute the importance of medication review for patients following a fracture but the question is who should do it,” an author said.

“We challenge all clinicians to work together to reduce the use of drugs linked to falls and fractures and to treat patients with drugs that can prevent subsequent fractures.”

“We also encourage patients who have experienced a fall or fracture to initiate a discussion with their doctors about the risks and benefits of medications associated with falls and bone loss.”