22 Aug Patients Remain On High Risk Drugs Even After A Fragility Fracture
MedicalResearch.com Interview with:
Jeffrey Munson, MD, MSCE
The Dartmouth Institute for Health Policy & Clinical Practice
Assistant Professor, Department of Medicine
Geisel School of Medicine at Dartmouth
MedicalResearch.com: What is the background for this study?
Response: Fragility fractures due to osteoporosis are a common and costly event among older Americans. Patients who experience one fragility fracture are at increased risk to have a second fracture. Our group is interested in exploring ways in which the risk of a second fracture could be reduced.
In this paper, we studied prescription drug use both before and after fracture. We know many prescription drugs have been shown to increase the risk of fracture, but we don’t know whether doctors try to reduce the use of these drugs after a fracture has occurred. Our study was designed to answer this question.
MedicalResearch.com: What are the main findings?
Response: Our first finding was that the use of prescription drugs that have been linked to fracture risk is very common in the US. More than three-quarters of Medicare patients who experience a fragility fracture were prescribed a drug that increases fracture risk in the 4 months prior to fracture.
Second, we found the number of patients using at least one of these drugs in the 4 months after fracture was nearly identical. This was true across the three main fracture types we studied (hip, wrist and upper arm). We did see that a small number of patients (about 7% overall) stopped using high-risk medications after fracture, but this was offset by a very similar number of patients who started taking such medications.
MedicalResearch.com: What should readers take away from your report?
Response: Our study suggests there is a need to develop and implement systems to ensure meaningful medication review occurs when patients experience a fracture. Ideally, when patients experience a fragility fracture, the healthcare team should review and reduce the use of medications that could contribute to subsequent fractures. Our study suggests this review process is not happening consistently, which may represent a missed opportunity to prevent future fragility fractures in patients we know are already at high risk for another fracture.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We are working to identify the drugs that carry the highest risk of a second fracture in order to help providers and patients weigh the risks and benefits of ongoing drug therapy after a fracture has occurred. Research addressing the development and testing of systems for meaningful medication review is also needed.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
- Jeffrey C. Munson, Julie P. W. Bynum, John-Erik Bell, Robert Cantu, Christine McDonough, Qianfei Wang, Tor D. Tosteson, Anna N. A. Tosteson. Patterns of Prescription Drug Use Before and After Fragility Fracture. JAMA Internal Medicine, 2016; DOI:10.1001/jamainternmed.2016.4814
- Sarah D. Berry, Douglas P. Kiel. Medication Review After a Fracture—Absolutely Essential. JAMA Internal Medicine, 2016; DOI:10.1001/jamainternmed.2016.4822
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