Combination of prescribed drugs heightens risk of fractures in the elderly

Doctors caring for elderly patients who have osteoporosis or who are at heightened risk of bone fractures, should take care when prescribing multiple medications.

A new study from The Dartmouth Institute for Health Policy and Clinical Practice has found a strong link between drug combinations and hip fracture.

˜With older adults consuming, on average, five medications simultaneously, we suspected that a good number of seniors are likely to use more than one of these fracture-associated drugs at a time," explains Rebecca Emeny, PhD, MPH, a research scientist at The Dartmouth Institute for Health Policy and Clinical Practice and lead author on the study. "We wanted to determine how that increased exposure would impact their risk for hip fractures, which are among the most painful, debilitating, deadly, and costly fractures one can experience."

The researchers looked at the prescription records of 2.5 million Medicare patients in the US. The study honed in on those had received treatment for hip fractures.

The more medicines people took, the higher their fracture risk.

On average, taking any one of these drugs doubled a person's risk, taking any two almost tripled it, and taking three or more increased fracture risk four-fold.

The riskiest mixture of drugs were opioids and sedatives, opioids and diuretics, and opioids and Proton pump inhibitors (PPIs).

The use of prescription medication has increased due to better diagnosis and an ageing population.

Experts believe that patients should talk to their consultant before stopping any treatment as stopping medication may not be the safest option. 

One of the biggest risk factors for fractures is osteoporosis. This condition thins the bones which makes them more vulnerable to a fracture. As part of natural ageing after the age of 35, bone loss increases very gradually.

However, bone loss becomes more rapid as we age, especially in women for several years following the menopause and can lead to osteoporosis and an increased risk of fractures.

Osteoporosis should be taken seriously by patients who are at risk of the condition. Certain fractures can cause premature death in people 45 and older.

What are the risk factors for osteoporosis?

  • Being slender and thin
  • Having a body mass index (BMI) of less than 21
  • A family history of osteoporosis
  • Women of European or Asian descent
  • An early menopause
  • Drug and alcohol addictions
  • Corticosteroids such as Prednisone
  • Epilepsy drugs
  • Taking oral glucocorticoids for three months or more
  • Breast or prostate cancer treatments
  • Thyroid problems
  • Parathyroid conditions such as hyperparathyroidism
  • Rheumatoid arthritis


One way of preventing this problem in future generations of women is by treating the early signs of osteoporosis - also known as osteopenia - with oestrogen in the form of hormone replacement treatment (HRT).

˜The safest and most effective way to increase bone density in women under the age of 60 years is by treatment with oestrogen,’ explains Professor Studd of the London PMS & Menopause Clinic in Wimpole Street, Marylebone. 'The denial of oestrogen to these younger women is tragic when we consider the many younger 30-40 year old women with premature menopause or with a history of anorexia and amenorrhea (lack of periods).'

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