Patterns of Prescription Drug Use Before and After Fragility Fracture

作者：Jeffrey C. Munson, Julie Bynum, John‐Erik Bell, Robert V. Cantu, Christine M. McDonough, Qianfei Wang, Tor D. Tosteson, Anna N.A. Tosteson · 发表于：JAMA Internal Medicine · 年份：2016 · DOI：10.1001/jamainternmed.2016.4814 · 被引用次数：80 · 研究领域：Bone health and osteoporosis research、Hip and Femur Fractures、Vitamin K Research Studies

IMPORTANCE: Patients who have a fragility fracture are at high risk for subsequent fractures. Prescription drugs represent 1 factor that could be modified to reduce the risk of subsequent fracture. OBJECTIVE: To describe the use of prescription drugs associated with fracture risk before and after fragility fracture. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study conducted between February 2015 and March 2016 using a 40% random sample of Medicare beneficiaries from 2007 through 2011 in general communities throughout the United States. A total of 168 133 community-dwelling Medicare beneficiaries who survived a fracture of the hip, shoulder, or wrist were included. Cohort members were required to be enrolled in fee-for-service Medicare with drug coverage (Parts A, B, and D) and to be community dwelling for at least 30 days in the immediate 4-month postfracture period. EXPOSURES: Prescription drug use during the 4-month period before and after a fragility fracture. MAIN OUTCOMES AND MEASURES: Prescription fills for drug classes associated with increased fracture risk were measured using Part D retail pharmacy claims. These were divided into 3 categories: drugs that increase fall risk; drugs that decrease bone density; and drugs with unclear fracture risk mechanism. Drugs that increase bone density were also tracked. RESULTS: A total of 168 133 patients with a fragility fracture (141 569 women; 84.2%) met the inclusion criteria for this study; 91.8% were white. Acro...