Dose changes may spur falls

Better coordinated care, including a review of medications, could lower the risk of falls and fractures in older adults who already have experienced fractures, according to a commentary published Monday in JAMA Internal Medicine.

Gerontologists at Beth Israel Deaconess Medical Center and the Hebrew SeniorLife Institute for Aging Research provided their opinion in response to a study published at the same time by researchers at the Geisel School of Medicine at Dartmouth. In the Dartmouth study, Jeffrey C. Munson, M.D., M.S.C.E., and coauthors found that few changes are made to seniors’ prescription medications in the four months after a fracture.

Eighty-five percent of the 168,133 older community-dwelling Medicare beneficiaries in the Dartmouth study were taking one or more of the drugs known to increase fracture risk in the four months before and after a hip, forearm or wrist fracture. The researchers also found that less than one-fourth of older adults with hip fractures were prescribed a common osteoporosis medication known to reduce the risk of fractures.

The commentary authors believe that those in orthopedics, rehabilitation services and primary care who are taking care of an older adult should coordinate efforts; discourage the use of sleep aids, sedatives and antidepressants that can cause dizziness or loss of balance in seniors; and prescribe medications known to prevent bone loss.

“Most clinicians wouldn’t dispute the importance of medication review for patients following a fracture, but the question is who should do it,” said corresponding author Sarah D. Berry, M.D., M.P.H., of BIDMC and Hebrew SeniorLife. “We challenge all clinicians to work together to reduce the use of drugs linked to falls and fractures and to treat patients with drugs that can prevent subsequent fractures. We also encourage patients who have experienced a fall or fracture to initiate a discussion with their doctors about the risks and benefits of medications associated with falls and bone loss.”

Complications of broken bones in the elderly can include death, pain, depression, infection, functional decline and subsequent fractures, the commentary authors noted.