Written by Peter Liu
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Gabapentinoid use is associated with an increased risk in hip fractures, particularly in patients with chronic kidney disease (CKD) or high frailty.
Synopsis
This study investigated the association between gabapentinoid use and the risk of hip fracture, with a focus on age, frailty, and CKD status. Utilizing a case-case-time-control design, the analysis included 2,946 patients aged 50 and older hospitalized for hip fractures in Victoria, Australia. Gabapentinoid use was linked to a 30% increase in fracture risk (OR 1.30, 95%CI 1.07-1.57), with elevated risk in patients with high frailty (OR 1.75, 95%CI 1.31-2.33) and CKD (OR 2.41, 95%CI 1.65-3.52). Limitations included potential residual confounding and reliance on dispensing data. The findings underscore caution in prescribing gabapentinoids, especially in vulnerable populations. (AI-assisted)
Heed the Beers Criteria – limit sedating medications in the elderly
Hip fractures are a serious health event in the elderly that frequently lead to death or permanent disability. This retrospective study from an Australian health database estimated a 30-140% increase in risk of hip fracture associated with gabapentinoid use. The population was predominantly female, and the medication prescribed was pregabalin in the majority of patients studied, so interpreting and generalizing this study can be challenging due to the gabapentinoid drug class. However, limiting polypharmacy remains one of the central tenets of geriatric care, and the results of this study support such a practice. As discussed in this paper, opioids, antidepressants, benzodiazepines, and many other drug classes have also been associated with similar odds ratios of hip fractures. I generally follow the American Geriatric Society 2023 Beers Criteria, which recommends avoiding more than two medications that inhibit the central nervous system as possible, and recommends extra caution in prescribing gabapentinoids for patients with renal dysfunction.
Source
Gabapentinoids and Risk of Hip Fracture. JAMA Netw Open. 2024 Nov 4;7(11):e2444488. doi: 10.1001/jamanetworkopen.2024.44488. PMID: 39535796
