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Medication Use Before and After Hip Fracture: A Population-Based Cohort and Case-Control Study

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Abstract

Background

Osteoporosis, together with age, is the main risk factor for hip fracture, the incidence of which has also been associated with an increased risk of falling or co-morbidities and related pharmacological treatments.

Objectives

The aim of this study was to investigate changes in concomitant pharmacological treatments prescribed before and after hip fracture in elderly patients compared with treatments prescribed to a matched cohort of subjects without hospitalisation for fractures.

Methods

Data relating to the study population were extracted from a large population-based administrative database of the Italian National Health Authorities. A retrospective analysis was conducted involving female patients (6,431) aged ≥65 years and hospitalised for a hip fracture. The control group comprised age-matched subjects (38,586) not hospitalised for fracture. Changes in drug prescriptions 1 year before and 1 year after hip fracture and differences versus controls were compared.

Results

Prior to the fracture, patients were taking more anti-Parkinson medications, antidepressants, medications for chronic obstructive pulmonary disease (COPD), bisphosphonates and calcium–vitamin D supplements, although the intake of the routinely monitored drug classes was significantly infrequent. Polypharmacy was less frequent in fractured women before fracture than in controls (22 vs. 25 %, respectively; P < 0.001), but it was more frequent (30 %, P < 0.001) post-fracture. The incidence of fracture was associated with a significant increase in the use of a number of drug classes: insulin, NSAIDs or analgesics, gastroprotectants, loop diuretics, β-blockers, antidepressants, antiparkinson drugs, antiepileptics and drugs for COPD.

Conclusion

Our study confirms a strong association between the use of some drugs (antidepressants, antiparkinson drugs, drugs for COPD) and the risk of hip fracture, but drug use is globally less common than in controls. Hip fracture is associated with a significant increase in drug use, suggesting a global deterioration of health conditions.

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Acknowledgments

Funding sources

This study was supported by independent research grants from Amgen Dompe and GlaxoSmithKline. The grant providers had no role in the study design, data collection, statistical analysis, or manuscript preparation and submission.

Conflict of interest

S.A. has received consultancy honoraria from Merck and Amgen, and speaking fees from Amgen, Abiogen, Merck, Eli-Lilly, Pfizer, Novartis and GSK. O.V. has received speaking fees from Merck and Pfizer. L.I. has received speaking fees from Novartis. L.D.E. has received speaking fees from Amgen and Eli-Lilly. D.G. has received speaking fees from Amgen, Abiogen, Merck, Eli-Lilly and Pfizer. All other authors have declared no conflicts of interest.

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Authors and Affiliations

  1. Rheumatology Unit, Department of Medicine, University of Verona, Policlinico Borgo Roma, Piazzale Scuro, 10, 37134, Verona, Italy

    Maurizio Rossini, Ombretta Viapiana, Silvano Adami, Luca Idolazzi & Davide Gatti

  2. CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy

    Stefano Buda, Chiara Veronesi & Luca Degli Esposti

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  1. Maurizio Rossini
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  2. Ombretta Viapiana
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Correspondence to Maurizio Rossini.

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Rossini, M., Viapiana, O., Adami, S. et al. Medication Use Before and After Hip Fracture: A Population-Based Cohort and Case-Control Study. Drugs Aging 31, 547–553 (2014). https://doi.org/10.1007/s40266-014-0184-2

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