New study suggests caution when combining fracture-associated medications for older adults

Many common medications prescribed to older adults, including opioids, antidepressants, antacids, and sleep aids, are known to carry an increased risk of fracture. Some increase the risk of falls, others weaken bones, or do both.

A new study published in JAMA Open Network found a strong association between the number of fracture-associated medications taken by older adults and their risk of fracture. The research showed that on average, taking any one of these drugs doubled a person’s risk, taking any two almost tripled it, and taking three or more increased fracture risk four-fold.

"With older adults consuming, on average, five medications simultaneously, we suspected that a good number of seniors are likely to use more than one of these fracture-associated drugs at a time," said lead study author Rebecca Emeny, PhD, MPH, a research scientist at the Dartmouth Institute for Health Policy and Clinical Practice, in a press statement.

Researchers measured 21 fracture-associated drugs and the 210 pairs in combination with these drugs. Fifty-five percent of the study participants took opioids (alone or in combination with others), 40% took diuretics, and 35% took PPIs. The most hazardous combinations were found to be opioids and sedatives, opioids and diuretics, and opioids and PPIs.

Examining 2.5 million Medicare beneficiaries’ records from 2004 through 2014, the researchers looked at the number and the specific fracture-associated drugs being taken by patients. They identified hip fracture diagnostic codes from inpatient claims, used statistical analysis to measure the risk of hip fracture associated with each medication, and then compared the findings to the hip fracture risk experienced by people who took none of the fracture-associated medications. Emeny said they wanted to look at hip fractures specifically because they are among the most painful, debilitating, deadly, and costly fractures.

Corresponding author Nancy Morden, MD, MPH, also from the Dartmouth Institute for Health Policy and Clinical Practice, noted in the press statement that the study results suggest caution when combining fracture-associated medications, “especially when use is discretionary, alternatives exist, or baseline fracture risk is high."