Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-22T11:54:08.025Z Has data issue: false hasContentIssue false
  • English
  • Français

Association between the use of benzodiazepines and opioids with the risk of falls and hip fractures in older adults

Published online by Cambridge University Press:  10 December 2017

Manuel E. Machado-Duque ,
Juan Pablo Castaño-Montoya ,
Diego A. Medina-Morales ,
Alejandro Castro-Rodríguez ,
Alexandra González-Montoya  and
Jorge E. Machado-Alba Open the ORCID record for Jorge E. Machado-Alba [Opens in a new window]
Manuel E. Machado-Duque
Affiliation:
Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia
Juan Pablo Castaño-Montoya
Affiliation:
Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia
Diego A. Medina-Morales
Affiliation:
Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia
Alejandro Castro-Rodríguez
Affiliation:
Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia
Alexandra González-Montoya
Affiliation:
Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia
Jorge E. Machado-Alba*
Affiliation:
Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia
*
Correspondence should be addressed to: Jorge Enrique Machado-Alba, Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia. Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 No. 14-140, Pereira, Risaralda, 660003Colombia. Phone: 57 3108326970; fax: +57 63137822. ORCID: 0000-0002-8455-0936. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

To determine the association between the use of opioids and benzodiazepines and the risk of falls with hip fracture in populations older than 65 years in Colombia.

Methods:

A case-control study with patients older than 65 years with diagnosis of hip fracture. Two controls were obtained per case. The drugs dispensed in the previous 30 days were identified. Sociodemographic, diagnostic, pharmacological (opioids and benzodiazepines), and polypharmacy variables were analyzed. A logistic regression model was used to analyze the risk of fall with hip fracture while using these drugs.

Results:

We included 287 patients with hip fractures and 574 controls. There was a female predominance (72.1%) and a mean age of 82.4 ± 8.0 years. Of the patients, 12.7% had been prescribed with opioids and 4.2% with benzodiazepines in the previous month. The adjusted multivariate analysis found that using opioids (OR:4.49; 95%CI:2.72–7.42) and benzodiazepines (OR:3.73; 95%CI:1.60–8.70) in the month prior to the event was significantly associated with a greater probability of suffering a fall with hip fracture.

Conclusions:

People who are taking opioids and benzodiazepines have increased risk for hip fracture in Colombia. Strategies to educate physicians regarding the pharmacology of older adults should be strengthened.

Keywords

opioidsbenzodiazepinesfallship fracturesfrail elderlyinappropriate prescribing
Type
Original Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 7: Issue Theme: Benzodiazepines and Hypnotics , July 2018 , pp. 941 - 946
Copyright
Copyright © International Psychogeriatric Association 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aizenberg, D., Weizman, A., Weiss, A., Akopian, M., Amitai, M. and Beloosesky, Y. (2015). The association in elderly hospitalized patients, between psychotropic drugs and hip fractures resulting from falls. Experimental Aging Research, 41, 546–555.Google Scholar
Berdot, S. et al. (2009). Inappropriate medication use and risk of falls–a prospective study in a large community-dwelling elderly cohort. BMC Geriatrics, 9, 30.Google Scholar
Chang, C. M., Wu, E. C., Chang, I. S. and Lin, K. M. (2008). Benzodiazepine and risk of hip fractures in older people: a nested case-control study in Taiwan. The American Journal of Geriatric Psychiatry, 16, 686–692.Google Scholar
Cummings, S. R. et al. (1995). Risk factors for hip fracture in white women. Study of osteoporotic fractures research group. The New England Journal of Medicine, 332, 767–773.Google Scholar
Danza, Á. et al. (2015). Benzodiazepinas y fractura de cadera: estudio de casos y controles. Revista Médica del Uruguay, 31, 120–127.Google Scholar
Dhanwal, D. K., Dennison, E. M., Harvey, N. C. and Cooper, C. (2011). Epidemiology of hip fracture: worldwide geographic variation. Indian Journal of Orthopaedics, 45, 15–22.Google Scholar
Donnelly, K., Bracchi, R., Hewitt, J., Routledge, P. A. and Carter, B. (2017). Benzodiazepines, Z-drugs and the risk of hip fracture: a systematic review and meta-analysis. PLoS One, 12, e0174730.Google Scholar
Ensrud, K. E. et al. (2003). Central nervous system active medications and risk for fractures in older women. Archives of Internal Medicine, 163, 949–957.Google Scholar
Eto, F., Saotome, I., Furuichi, T. and Ogasawara, M. (1998). Effects of long-term use of benzodiazepines on gait and standing balance in the elderly. Annals of the New York Academy of Sciences, 860, 543–545.Google Scholar
Fraser, L. A. et al. (2014). Effect of anticholinergic medications on falls, fracture risk, and bone mineral density over a 10-year period. Annals of Pharmacotherapy, 48, 954–961.Google Scholar
Herings, R. C., Stricker, B., de Boer, A., Bakker, A. and Sturmans, F. (1995). Benzodiazepines and the risk of falling leading to femur fractures: dosage more important than elimination half-life. Archives of Internal Medicine, 155, 1801–1807.Google Scholar
Jyrkka, J., Enlund, H., Korhonen, M. J., Sulkava, R. and Hartikainen, S. (2009). Polypharmacy status as an indicator of mortality in an elderly population. Drugs Aging, 26, 1039–1048.Google Scholar
King, M. and Lipsky, M. S. (2015). Clinical implications of aging. Disease-a-Month, 61, 467–474.Google Scholar
Kinjo, M., Setoguchi, S., Schneeweiss, S. and Solomon, D. H. (2005). Bone mineral density in subjects using central nervous system-active medications. The American Journal of Medicine, 118, 1414.Google Scholar
Landi, F. et al. (2014). Anticholinergic drug use and negative outcomes among the frail elderly population living in a nursing home. Journal of the American Medical Directors Association, 15, 825–829.Google Scholar
Machado-Alba, J. E., Castro-Rodriguez, A., Alzate-Piedrahita, J. A., Hoyos-Pulgarin, J. A. and Medina-Morales, D. A. (2016). Anticholinergic risk and frequency of anticholinergic drug prescriptions in a population older than 65. Journal of the American Medical Directors Association, 17, 275.Google Scholar
de Salud, Ministerio y Social, Protección (2013). Envejecimiento Demográfico. Colombia 1951–2020 Dinámica Demográfica y Estructuras Poblacionales. Bogotá, D.C. Colombia: Ministerio de Salud y Protección Social.Google Scholar
Melton, L. J. 3rd (2000). Who has osteoporosis? A conflict between clinical and public health perspectives. Journal of Bone and Mineral Research, 15, 2309–2314.Google Scholar
Morales-Torres, J. and Gutierrez-Urena, S. (2004). The burden of osteoporosis in Latin America. Osteoporosis International, 15, 625–632.Google Scholar
O'Loughlin, J. L., Robitaille, Y., Boivin, J. F. and Suissa, S. (1993). Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. American Journal of Epidemiology, 137, 342–354.Google Scholar
Onda, M., Imai, H., Takada, Y., Fujii, S., Shono, T. and Nanaumi, Y. (2015). Identification and prevalence of adverse drug events caused by potentially inappropriate medication in homebound elderly patients: a retrospective study using a nationwide survey in Japan. BMJ Open, 5, e007581.Google Scholar
Orces, C. H. (2009). Epidemiology of hip fractures in Ecuador. Revista Panamericana de Salud Pública, 25, 438–442.Google Scholar
Passaro, A., Volpato, S., Romagnoni, F., Manzoli, N., Zuliani, G. and Fellin, R. (2000). Benzodiazepines with different half-life and falling in a hospitalized population: the GIFA study. Gruppo Italiano di Farmacovigilanza nell'Anziano. Journal of Clinical Epidemiology, 53, 1222–1229.Google Scholar
Ping, F. et al. (2017). Opioids increase hip fracture risk: a meta-analysis. Journal of Bone and Mineral Metabolism, 35, 289–297.Google Scholar
Ray, W. A., Griffin, M. R. and Downey, W. (1989). Benzodiazepines of long and short elimination half-life and the risk of hip fracture. Jama, 262, 3303–3307.Google Scholar
Solomon, D. H., Rassen, J. A., Glynn, R. J., Lee, J., Levin, R. and Schneeweiss, S. (2010). The comparative safety of analgesics in older adults with arthritis. Archives of Internal Medicine, 170, 1968–1976.Google Scholar
Swift, C. G., Swift, M. R., Hamley, J., Stevenson, I. H. and Crooks, J. (1984). Side-effect ‘tolerance’ in elderly long-term recipients of benzodiazepine hypnotics. Age and Ageing, 13, 335–343.Google Scholar
Takkouche, B., Montes-Martinez, A., Gill, S. S. and Etminan, M. (2007). Psychotropic medications and the risk of fracture: a meta-analysis. Drug Safety, 30, 171–184.Google Scholar
Tello, S. D., Arribas, B. R., Martínez, E. L. and Pérez, J. C. (2007). Uso de los opioides en pacientes con dolor oncológico. SEMERGEN-Medicina de Familia, 33, 520–528.Google Scholar
Teng, Z. et al. (2015). Opioids contribute to fracture risk: a meta-analysis of 8 cohort studies. PLoS One, 10, e0128232.Google Scholar
Tinetti, M. E., Speechley, M. and Ginter, S. F. (1988). Risk factors for falls among elderly persons living in the community. The New England Journal of Medicine, 319, 1701–1707.Google Scholar
Vestergaard, P., Rejnmark, L. and Mosekilde, L. (2006). Fracture risk associated with the use of morphine and opiates. Journal of Internal Medicine, 260, 76–87.Google Scholar
Vestergaard, P., Rejnmark, L. and Mosekilde, L. (2007). Fracture risk associated with parkinsonism and anti-Parkinson drugs. Calcified Tissue International, 81, 153–161.Google Scholar
Wagner, A. K. et al. (2004). Benzodiazepine use and hip fractures in the elderly: who is at greatest risk? Archives of Internal Medicine, 164, 1567–1572.Google Scholar
Willcox, S. M., Himmelstein, D. U. and Woolhandler, S. (1994). Inappropriate drug prescribing for the community-dwelling elderly. Jama, 272, 292–296.Google Scholar
Xing, D., Ma, X. L., Ma, J. X., Wang, J., Yang, Y. and Chen, Y. (2014). Association between use of benzodiazepines and risk of fractures: a meta-analysis. Osteoporosis International, 25, 105–120.Google Scholar
Yayla, E. M., Yavuz, E., Bilge, U., Keskin, A. and Binen, E. (2015). Drugs with anticholinergic side-effects in primary care. Nigerian Journal of Clinical Practice, 18, 18–21.Google Scholar