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The drugs causing falls and fractures in the elderly

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Many of the drugs routinely prescribed to the elderly – opioid painkillers, antidepressants, antacids and sleeping drugs – either weaken the bones or increase the chances of a fall or do both.

Researchers from the Geisel School of Medicine at Dartmouth analysed the records of around 2.5 million older people who had been prescribed any of the 21 most common fracture-associated drugs (FADs) to see how many of them subsequently suffered a hip fracture.

The rate was highest among those who were taken the most FADs, and the most commonly prescribed were opioid painkillers, which were taken by 55 percent of the group, followed by diuretics, prescribed to 40 percent of them.

Taking even one of these drugs doubles the risk of a fracture, the researchers estimate, and the risk increases exponentially for every other FAD being taken. Taking two FADs triples the risk and taking three quadruples it. The effects can be twice as bad in people who already have osteoporosis.

The most dangerous combinations – and the ones most likely to lead to a fall or fracture – were the opioids and sedatives, or opioids and diuretics, or opioids and PPIs (proton pump inhibitors), for indigestion.

If the drugs are optional, the elderly patient should seriously consider stop taking them, the researchers say, and it’s a consideration that is even more pressing if two or more FADs are being prescribed.

(Source: JAMA Network Open, 2019; 2: e1915348)

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