title: Association of polypharmacy with fall-related fractures in older Taiwanese people: age- and gender-specific analyses.
abstract: OBJECTIVE
  To elucidate the associations between polypharmacy and age- and gender-specific risks of admission for fall-related fractures.
  
  
  METHODS
  Nested case-control study.
  
  
  METHODS
  This analysis was randomly selected from all elderly beneficiaries in 2007-2008, and represents some 30% of the whole older insurers using Taiwan's National Health Insurance Research Database.
  
  
  METHODS
  We identified 5933 cases newly admitted for fall-related fractures during 2007-2008, and 29 665 random controls free from fracture.
  
  
  METHODS
  Polypharmacy was defined as the use of fall-related drugs of four or more categories of medications and prescribed related to fall within a 1-year period. Logistic regression models were employed to estimate the ORs and related 95% CIs. The interaction of polypharmacy with age and sex was assessed separately.
  
  
  RESULTS
  Compared with those who consumed no category of medication, older people who consumed 1, 2, 3 and ≥4 categories of medications were all at significantly increased odds of developing fall-related fractures, with a significant dose-gradient pattern (β=0.7953; p for trend <0.0001). There were significant interactions between polypharmacy and age, but no significant interactions between polypharmacy and gender. The dose-gradient relationship between number of medications category and risk of fall-related fractures was more obvious in women than in men (β=0.1962 vs β=0.1873). Additionally, it was most evident in older people aged 75-84 years (β=0.2338).
  
  
  CONCLUSIONS
  This population-based study in Taiwan confirms the link between polypharmacy and increased risk of fall-related fractures in older people; and highlights that elderly women and older people aged 75-84 years will be the targeted participants for further prevention from fall-related fractures caused by polypharmacy.
authors.affiliation: Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan.
authors.forename: Hsueh-Hsing
authors.initials: HH
authors.lastname: Pan
authors.forename: Chung-Yi
authors.initials: CY
authors.lastname: Li
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Tung-Ping
authors.initials: TP
authors.lastname: Su
authors.forename: Kwua-Yun
authors.initials: KY
authors.lastname: Wang
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D019338:Polypharmacy; D055553:Prescription Drugs / Q000008:administration & dosage*; D012307:Risk Factors; D012737:Sex Factors; D013624:Taiwan
chemical_list: D055553:Prescription Drugs
keywords: GENERAL MEDICINE (see Internal Medicine); GERIATRIC MEDICINE; PREVENTIVE MEDICINE