Older Adults' Medication Use 6 Months Before and After Hip Fracture: A Population-Based Cohort Study

OBJECTIVES: To study changes in use of fall-risk increasing drugs (FRIDs) and bone density-related medication in participants with hip fracture before and after the fracture and to analyze differences between five healthcare districts. DESIGN: Population-based cohort study. SETTING: Data retrieved from two national databases PARTICIPANTS: All 2,043 people with hip fracture aged 60 and older in a Swedish county in 2006. MEASUREMENTS: Changes in FRIDs and bone-active medications prescribed within 6 months before and 6 months after hip fracture and differences between health care districts. RESULTS: Before hip fracture, 1,308 participants (67.7%) received any FRIDs or combinations; after fracture, 97.7% were treated. Polypharmacy (>= 5 drugs) increased 39.3%, excessive polypharmacy (>= 10 drugs) increased 36.4%, and use of three or more psychotropic drugs increased 8.6%. After fracture, the use of all analyzed drugs including psychotropic, cardiovascular, opioid, and anticholinergic drugs increased significantly (P < . 001). Treatment with calcium and vitamin D increased from 9% before to 27.7% after and with bisphosphonates from 3.5% to 7.6%. Variations in postfracture prescribing between the five health care districts were observed regarding opioids (range 85-64%), bisphosphonates (range 20-4%), and calcium and vitamin D (72-13%) (P < .001, for all comparisons). CONCLUSION: Two-thirds of participants with hip fracture were prescribed FRIDs before fracture, and the number increased significantly after fracture. Significant variations between healthcare districts in treating osteoporosis and pain were evident; geriatric support could be a contributing factor to the greater treatment in two districts. J Am Geriatr Soc 59:863-868, 2011.