Medication use before and after hip fracture: a population-based cohort and case-control study.
BACKGROUND
Osteoporosis, together with age, is the main risk factor for hip fracture, the incidence of which has also been associated with an increased risk of falling or co-morbidities and related pharmacological treatments.


OBJECTIVE
The aim of this study was to investigate changes in concomitant pharmacological treatments prescribed before and after hip fracture in elderly patients compared with treatments prescribed to a matched cohort of subjects without hospitalisation for fractures.


METHODS
Data relating to the study population were extracted from a large population-based administrative database of the Italian National Health Authorities. A retrospective analysis was conducted involving female patients (6,431) aged ≥65 years and hospitalised for a hip fracture. The control group comprised age-matched subjects (38,586) not hospitalised for fracture. Changes in drug prescriptions 1 year before and 1 year after hip fracture and differences versus controls were compared.


RESULTS
Prior to the fracture, patients were taking more anti-Parkinson medications, antidepressants, medications for chronic obstructive pulmonary disease (COPD), bisphosphonates and calcium-vitamin D supplements, although the intake of the routinely monitored drug classes was significantly infrequent. Polypharmacy was less frequent in fractured women before fracture than in controls (22 vs. 25 %, respectively; P < 0.001), but it was more frequent (30 %, P < 0.001) post-fracture. The incidence of fracture was associated with a significant increase in the use of a number of drug classes: insulin, NSAIDs or analgesics, gastroprotectants, loop diuretics, β-blockers, antidepressants, antiparkinson drugs, antiepileptics and drugs for COPD.


CONCLUSIONS
Our study confirms a strong association between the use of some drugs (antidepressants, antiparkinson drugs, drugs for COPD) and the risk of hip fracture, but drug use is globally less common than in controls. Hip fracture is associated with a significant increase in drug use, suggesting a global deterioration of health conditions.
Rheumatology Unit, Department of Medicine, University of Verona, Policlinico Borgo Roma, Piazzale Scuro, 10, 37134, Verona, Italy, maurizio.rossini@univr.it.
Maurizio
M
Rossini
Ombretta
O
Viapiana
Silvano
S
Adami
Luca
L
Idolazzi
Stefano
S
Buda
Chiara
C
Veronesi
Luca
L
Degli Esposti
Davide
D
Gatti
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D015331:Cohort Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006620:Hip Fractures / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D019338:Polypharmacy; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology
D000928:Antidepressive Agents; D000978:Antiparkinson Agents