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Doctors should reconsider some medications after fracture, researchers say

Too few patients have high-risk medications changed after a fracture, and too few are prescribed drugs to minimize the risk of future fractures after injury.

By Stephen Feller
Doctors should reconsider some medications after fracture, researchers say
Researchers say some patients should not be on drugs that may affect balance, cognition or increase risk of fall if they are already at high risk, and they should be taken off the drugs after sustaining a fractured bone to prevent secondary injury. Photo by Toa55/Shutterstock

BOSTON, Aug. 22 (UPI) -- Even after a fracture, researchers report continued use of prescription drugs that may increase the risk for future injuries without adding medication that may reduce that risk.

Researchers at Dartmouth University and Harvard University report in a new study, published in the journal JAMA Internal Medicine, that prescriptions linked to increased fracture risk are rarely changed, suggesting doctors are missing opportunities to prevent secondary injuries.

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Roughly half of all women and a quarter of men over age 50 are likely to experience some type of bone fracture, with particular concern for those with hip fractures or at high risk for them. According to the researchers, nearly half of all individuals with hip fractures are readmitted to the hospital and one of every five die in the first year following such an injury.

The concern is that prescription drugs that may affect balance or cognition and result in injuries continue to be used with a group of patients at higher risk for worse health conditions after a fall or fracture, and for many patients, drugs that would strengthen bones are not used to prevent injuries.

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"Far too often clinicians fail to perform a thoughtful medication review for patients with a fracture or to act on this review," Dr. Sarah Berry and Dr. Douglas Keil, researchers at Harvard who were not involved with the new study, wrote in a commentary published in JAMA Internal Medicine with the study. "A thoughtful review should include a discussion of reducing or eliminating medications associated with falls and bone loss whenever possible."

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For the study, researchers at Dartmouth reviewed a 40 percent random sample of prescription fills for Medicare beneficiaries between 2007 and 2011, analyzing medical records for 168,133 patients who survived a fracture of the hip, shoulder or wrist.

After reviewing prescriptions from four months before an injury to four months after an injury, the researchers found 77.1 percent of hip fracture patients, 74.1 percent of wrist fracture patients and 75.9 percent of shoulder fracture patients had been exposed to at least one drug linked to higher risk of breaking a bone.

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Only about 7 percent of the patients discontinued the drug after their injury. The researchers report drugs used to strengthen bone density -- commonly prescribed to patients as they get past age 50 -- were prescribed for less than 25 percent of any patient before or after a fracture.

Though they note primary care physicians are responsible for many of the prescriptions, Berry and Keil say they are generally not the doctors treating a fracture. The doctors who do treat these injuries should be conducting medication reviews as part of patient care, however, and methods should be put in place to improve the care of older fracture patients.

"The transient nature of postfracture rehabilitation makes it equally unlikely that the responsibility for medication review will reside in the skilled nursing facility or as part of orthopedic follow-up," the researchers wrote. "Clinicians in these settings may have limited resources or knowledge to initiate a comprehensive medication review. All clinicians who care for a patient following a fracture should review medications with special attention to psychotropic drugs and drugs that can prevent fractures."

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