Abstract
Purpose
To describe the demographic and clinical characteristics and the pre-fracture exposure to medicines of patients admitted for a hip fracture, and to explore their association with fatal outcome 1 year after the fracture.
Methods
All patients ≥65 years old admitted for a hip fracture in a tertiary hospital in Barcelona between January 1 and December 31 2007 were included. Data on the patients’ clinical characteristics before and during hospital admission and on pre-fracture exposures to medicines were collected from the clinical records. One-year mortality was checked by approaching the patients and their families and was cross-checked with the national mortality statistics database. A Cox proportional hazards analysis was carried out.
Results
Four hundred and fifty-six patients [mean age (SD) 82.9 (7.2) years, 73.5 % female], were admitted with hip fracture during the study period. Almost 80 % of the patients (363, 79.6 %) had three or more associated conditions, and 41.7 % received pre-fracture treatment with five or more drugs. The case-fatality rate during hospital admission was 4.6 % (21 patients). One hundred and seven patients died within 1 year (23.5 %). Advanced age, male gender, two or more associated chronic conditions, cancer, severe cognitive impairment, and treatment with opiates before fracture were significantly associated with the risk of dying. An inverse association was recorded between mortality and pre-hospital exposure to medicines for osteoporosis.
Conclusions
One-quarter of patients admitted for hip fracture died within 1 year after the fracture. Exposure to opiates before hip fracture was associated with an increased 1-year death rate, whereas treatment with drugs for osteoporosis was associated with a decrease in death rate. These results should be confirmed in studies with detailed prospective collection of information on exposure to medicines.
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References
Johnell O, Kanis JA (2004) An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 15:897–902
Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20:1633–1650
Hershkovitz A, Polatov I, Beloosesky Y, Brill S (2010) Factors affecting mortality of frail hip-fractured elderly patients. Arch Gerontol Geriatr 51:113–116
Lyles KW, Colón-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, Hyldstrup L, Recknor C, Nordsletten L, Moore KA, Lavecchia C, Zhang J, Mesenbrink P, Hodgson PK, Abrams K, Orloff JJ, Horowitz Z, Eriksen EF, Boonen S, for the HORIZON Recurrent Fracture Trial (2007) Zoledronic acid and clinical fracture and mortality after hip fracture. N Engl J Med 357:1799–1809
Nurmi-Lüthje I, Lüthje P, Kaukonen JP, Kataja M, Kuurne S, Naboulsi H, Karjalainen K (2009) Post-fracture prescribed calcium and vitamin D supplements alone or, in females, with concomitant anti-osteoporotic drugs is associated with lower mortality in elderly hip fracture patients: a prospective analysis. Drugs Aging 26:409–421
Nurmi-Lüthje I, Sund R, Juntunen M, Lüthje P (2011) Post-hip fracture use of prescribed calcium plus vitamin D or vitamin D supplements and anti-osteoporotic drugs is associated with lower mortality: a nationwide study in Finland. J Bone Miner Res. doi:10.1002/jbmr.375
Alvarez-Nebreda ML, Jiménez AB, Rodríguez P, Serra JA (2008) Epidemiology of hip fracture in the elderly in Spain. Bone 42:278–285
Alegre-López J, Cordero-Guevara J, Alonso-Valdivielso JL, Fernández-Melón J (2005) Factors associated with mortality and functional disability after hip fracture: an inception cohort study. Osteoporos Int 16:729–736
Brossa Torruella A, Tobías Ferrer J, Zorrilla Ribeiro J, López Borras E, Alabart Teixidó A, Belmonte Garridof M (2005) Mortality after hip fracture: a three year follow-up study [in Spanish]. Med Clin (Barc) 124:53–54
Folstein MF, Folstein SE, Mchugh PR, Fanjiang G (2001) Mini-mental state examination user’s guide. Psychological Assessment Resources, Odessa
Kenzora JE, McCarthy RE, Lowell JD, Sledge CB (1984) Hip fracture mortality: relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res 186:45–56
Jette AM, Harris BA, Cleary PD, Campion EW (1987) Functional recovery after hip fracture. Arch Phys Med Rehabil 68:735–740
Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1989) Survival experience of aged hip fracture patients. Am J Public Health 79:274–278
Egol KA, Koval KJ, Zuckerman JD (1997) Functional recovery following hip fracture in the elderly. J Orthop Trauma 11:594–599
Bass E, French DD, Bradham DD, Rubenstein LZ (2007) Risk-adjusted mortality rates of elderly veterans with hip fractures. Ann Epidemiol 17:514–519
Leibson CL, Tosteson ANA, Gabriel SE, Ransom JE, Melton LJ (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 50:1644–1650
Röder F, Schwab M, Aleker T, Mörike K, Thon KP, Klotz U (2003) Proximal femur fracture in older patients—rehabilitation and clinical outcome. Age Ageing 32:74–80
Beloosesky Y, Weiss A, Grinblat J, Hershkovitz A (2004) Can functional status, after rehabilitation, independently predict long-term mortality of hip fractured elderly patients? Aging Clin Exp Res 16:44–48
Boereboom FT, Raymakers JA, Duursma SA (1992) Mortality and causes of death after hip fracture in the Netherlands. Neth J Med 41:4–10
Doruk H, Mas MR, Yildiz C, Sonmez A, Kýrdemir V (2004) The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly. Arch Gerontol Geriatr 39:179–185
Jiang HX, Majumdar SR, Dick DA, Moreau M, Raso J, Otto DD, Johnston DW (2005) Development and initial validation of a risk score for predicting in hospital and 1-year mortality in patients with hip fractures. J Bone Miner Res 20:494–500
Pioli G, Barone A, Giusti A, Oliveri M, Pizzonia M, Razzano M, Palummeri E (2006) Predictors of mortality after hip fracture: results from 1-year follow-up. Aging Clin Exp Res 18:381–387
Sexson SB, Lehner JT (1987) Factors affecting hip fracture mortality. J Orthop Trauma 1:298–305
Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD (1997) Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma 11:162–165
Miller CW (1978) Survival and ambulation following hip fracture. J Bone Joint Surg Am 60:930–934
Endo Y, Aharonoff GB, Zuckerman JD, Egol KA, Koval KJ (2005) Gender differences in patients with hip fracture: a greater risk of morbidity and mortality in men. J Orthop Trauma 19:29–35
Vestergaad P, Rejnmark L, Mosekilde L (2006) Fracture risk associated with the use of morphine and opiates. J Intern Med 260:76–87
Ensrud K, Blackwell T, Mangione C, Bowman PJ, Bauer DC, Schwartz A, Hanlon JT, Nevitt MC, Whooley MA, Study of Osteoporotic Fractures Research Group (2003) Central nervous system active medications and risk for fractures in older women. Arch Intern Med 163:949–957
French DD, Campbell R, Spehar A, Rubenstein LZ, Branch LG, Cunningham F (2007) National outpatient medication profiling: medications associated with outpatient fractures in community-dwelling elderly veterans. Br J Clin Pharmacol 63:238–244
Spector W, Shaffer T, Potter E, Correa-de-Araujo R, Rhona Limcangco M (2007) Risk factors associated with the occurrence of fractures in U.S. nursing homes: resident and facility characteristics and prescription medications. J Am Geriatr Soc 55:327–33
Saunders KW, Dunn KM, Merrill JO, Sullivan M, Weisner C, Braden JB, Psaty BM, Von Korff M (2010) Relationship of opioid use and dosage levels to fractures in older chronic pain patients. J Gen Intern Med 25:310–315
Anonymous (2006) Transdermal fentanyl: a misunderstood dosage form. ISMP Can Safety Bull 6. http://www.ismp-canada.org/download/safetyBulletins/ISMPCSB2006-05Fentanyl.pdf. Accessed 15 Jul 2011
McMorran M, Longo M (2008) Fentanyl transdermal patch and fatal adverse reactions. Can Adv React Newsl 18:1–2
Paulozzi LJ, Ryan GW (2006) Opioid analgesics and rates of fatal drug poisoning in the United States. Am J Prev Med 31:506–511
Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, Weisner CM, Silverberg MJ, Campbell CI, Psaty BM, Von Korff M (2010) Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med 52:85–92
Hall AJ, Logan JE, Toblin RL, Kaplan JA, Kraner JC, Bixler D, Crosby AE, Paulozzi LJ (2008) Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA 300:2613–2620
Zerzan JT, Morden NE, Soumerai S, Ross-Degnan D, Roughead E, Zhang F, Simoni-Wastila L, Sullivan SD (2006) Trends and geographic variation of opiate medication use in state Medicaid fee-for-service programs: 1996 to 2002. Med Care 44:1005–1010
Caudill-Slosberg M, Schwartz L, Woloshin S (2004) Office visits and analgesic prescriptions for musculoskeletal pain in US: 1980 vs. 2000. Pain 109:514–519
Parsells Kelly J, Cook SF, Kaufman DW, Anderson T, Rosenberg L, Mitchell AA (2008) Prevalence and characteristics of opioid use in the US adult population. Pain 138:507–513
Okie S (2010) A flood of opioids, a rising tide of deaths. N Engl J Med 363:1981–1985
van der Hooft CS, Schoofs MWCJ, Ziere G, Hofman A, Pols HA, Sturkenboom MC, Stricker BH (2008) Inappropriate benzodiazepine use in older adults and the risk of fracture. B J Clin Pharmacol 66:276–282
Hugenholtz GW, Heerdink ER, van Staa TP, Nolen WA, Egberts AC (2005) Risk of hip/femur fractures in patients using antipsychotics. Bone 37:864–70
Bolton JM, Metge C, Lix L, Prior H, Sareen J, Leslie WD (2008) Fracture risk from psychotropic medications: a population-based analysis. J Clin Psychopharmacol 28:384–391
Yang Y-X, Lewis JD, Epstein S, Metz DC (2006) Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 296:2947–2953
Kannegaard PN, Van der Mark S, Eiken P, Abrahamsen B (2010) Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 39:203–209
Juliebø V, Krogseth M, Skovlund E, Engedal K, Wyller TB (2010) Medical treatment predicts mortality after hip fracture. J Gerontol 65A:442–449
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Agustí, A., Pagès, E., Cuxart, A. et al. Exposure to medicines among patients admitted for hip fracture and the case-fatality rate at 1 year: a longitudinal study. Eur J Clin Pharmacol 68, 1525–1531 (2012). https://doi.org/10.1007/s00228-012-1273-y
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DOI: https://doi.org/10.1007/s00228-012-1273-y