Exposure to medicines among patients admitted for hip fracture and the case-fatality rate at 1 year: a longitudinal study

• Published in: European journal of clinical pharmacology Vol. 68; no. 11; pp. 1525 - 1531
• Main Authors: Agustí, A., Pagès, E., Cuxart, A., Ballarín, E., Vidal, X., Teixidor, J., Tomás, J., Villar, M. M., Laporte, J.-R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-11-2012; Springer; Springer Nature B.V
• Subjects: Age; Aged; Aged, 80 and over; Aging; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Bone Density Conservation Agents - adverse effects; Bone Density Conservation Agents - therapeutic use; Cancer; Cognition Disorders - complications; Cognition Disorders - physiopathology; Cognitive ability; Data processing; Demography; Diseases of the osteoarticular system; Drugs; Female; Fractures; Hip; Hip Fractures - complications; Hip Fractures - physiopathology; Hip Fractures - rehabilitation; Hip Fractures - therapy; Hip joint; Home Care Services; Hospital Mortality; Hospitals; Hospitals, Urban; Humans; Longitudinal Studies; Male; Medical sciences; Mortality; Opiates; Osteoporosis; Osteoporosis - drug therapy; Osteoporosis - physiopathology; Osteoporosis. Osteomalacia. Paget disease; Osteoporotic Fractures - complications; Osteoporotic Fractures - physiopathology; Osteoporotic Fractures - rehabilitation; Osteoporotic Fractures - therapy; Pain - drug therapy; Pain - etiology; Pain - prevention & control; Pharmacoepidemiology and Prescription; Pharmacology; Pharmacology. Drug treatments; Pharmacology/Toxicology; Severity of Illness Index; Sex Characteristics; Spain - epidemiology; Statistical analysis; Survival Analysis; Spain; Femoral neck fracture; Hip fracture; Osteoporotic hip fracture; Mortality; Femoral neck; Human; Diseases of the osteoarticular system; Exposure; Fracture; Trauma; Hip; Medicine; Osteoporosis; Follow up study
• ISSN: 0031-6970; 1432-1041
• DOI: 10.1007/s00228-012-1273-y

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.