Examine examines variation in depth of fracture-associated prescription drug use

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Findings from a new Geisel-led study published in the Journal of General Internal Medicine show that the intensity of fracture-associated medication (FAD) use among residents of long-term care facilities varies significantly across regions of the country. and that areas with greater use of these prescription drugs have higher hip fracture rates.

In the past few decades, prescription drug use in the United States has increased dramatically due to factors such as improving ability to detect disease, expanding treatment options, and an aging population. For many Americans over the age of 65, these drugs provide an effective means of treating disease and improving quality of life and longevity.

However, many commonly prescribed medications – such as opioid pain relievers, sleeping pills, diuretics, antidepressants, and antacids – are known to increase the risk of fractures by making falls worse, weakening bones, or both. This is especially true for patients whose risk of fracture due to diseases such as osteoporosis is already high.

"In our previous research, we showed that combining three or more FADs posed a four-fold risk of hip fractures for Medicare beneficiaries and that exposure to these drugs for residents of long-term care facilities was almost twice that of those living in of the community, "says Rebecca Emeny, Ph.D., MPH, research fellow at the Dartmouth Institute for Health Policy and Clinical Practice and lead author of the study.

In this study, the researchers wanted to determine the extent to which the intensity of FAD use (from a list of 21 FADs) in long-term care facilities differs from region to region, and to assess the relationship between this intensity and hip fracture rates. They analyzed Medicare administrative records and prescribing records for 422,111 long-term care residents, compared FAD use in referral areas of hospitals, and observed more than 36,409 hip fractures in these residents over an eight-year period (2006-2014).

Areas with the greatest intensity of multiple FAD use (with at least three mandatory FADs) were in the southeast in Gulfport and Oxford, Mississippi; Alexandria and Monroe, Louisiana; and Miami, Florida; while the areas of lowest intensity were in Bronx, New York; Bend, Oregon; Albuquerque, New Mexico; Honolulu, Hawaii; and Sun City, Arizona.

The researchers found an average difference of 12 percent in the area of ​​FAD prescribing when comparing referral regions from hospitals. They also found that residents of the prescription areas with the highest intensity were about 14 percent higher at risk of fractures compared to the lowest.

"The fact that the intensity of prescribing these risky drugs varies so widely among this vulnerable population adds to the evidence that guidelines are not necessarily followed," says Emeny. "We hope that these results will help to weigh the risks and benefits more carefully when combinations of these drugs are prescribed."

The study assesses the risk of fractures for patients taking multiple medications

More information:
Rebecca T. Emeny et al., Regional Variation in Fracture-Associated Prescription Drug Use and Hip Fractures in Long-Term Care: An Observational Study, Journal of General Internal Medicine (2021). DOI: 10.1007 / s11606-020-06477-8

Provided by
The Geisel School of Medicine at Dartmouth

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