Missed Opportunities to Prevent Secondary Fractures

Exposure to prescription drugs associated with fracture risk was not consistently reduced after a fragility fracture occurrence, researchers reported in a JAMA Internal Medicine article.

Patients with a fragility fracture occurrence have a higher risk for subsequent fractures and use of prescription drugs is a modifiable factor in reducing this risk. Study authors evaluated the use of prescription drugs associated with fracture risk pre- and post-fragility fracture. They conducted a retrospective cohort study between February 2015–March 2016 using a sample of Medicare beneficiaries (40% random) from 2007–2011. 

A total of 168,133 beneficiaries who survived a fracture of the hip, shoulder, or wrist were included for the analysis. They were required to be community dwelling for ≥30 days in the immediate 4-month post-fracture period. Main outcome measures included prescription fills for drug classes with increased fracture risk. These fill claims were divided into three categories: drugs that increase fall risk, drugs that decrease bone density, and drugs with unclear fracture risk mechanism. In addition, study authors tracked exposure to drugs that increased bone density. 

The data showed varied frequency of discharge to a rehabilitation institution following hospitalization based on fracture type, however the mean duration of acute rehabilitation did not vary based on fracture type (28.1 days). Most patients were exposed to ≥1 non-opioid drug associated with increased fracture risk in the 4 months pre-fracture (77.1% [hip], 74.1% [wrist], 75.9% [shoulder]). About 7% of these patients discontinued this drug exposure post-fracture but this value was offset by new users post-fracture. 

The proportion of the group exposed post-fracture remained unchanged (80.5% [hip], 74.3% [wrist], 76.9% [shoulder]). Also, there was no change in the average number of fracture-associated drugs used. 

Study authors concluded this same pattern of drug use pre- and post-exposure was seen across all three drug mechanism categories. Bone density strengthening medications were not commonly used pre- and post-fracture (≤25%), they noted. Although some patients discontinued their exposure to drugs associated with fracture, the same number of patients initiated new high-risk medications. 

The study’s findings suggest a possibly missed opportunity to modify ≥1 factor contributing to secondary fractures. “While some patients eliminate their exposure to drugs associated with fracture, an equal number initiate new high-risk drugs… [suggesting] there is a missed opportunity to modify at least one factor contributing to secondary fractures,” the authors concluded. 

Reference

Munson JC, Bynum JP, Bell JE, et al. Patterns of Prescription Drug Use Before and After Fragility Fracture. JAMA Intern Med. 2016 Aug 22. doi:10.1001/jamainternmed.2016.4814 [Epub ahead of print] 

This article originally appeared on MPR