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The findings of a new study suggest that patients who suffer bone fractures often continue to take drugs that may have been responsible, increasing the risk that they will suffer additional fractures in the future.
Researchers from the Geisel School of Medicine at Dartmouth found that more than 1-in-10 older patients who suffer a bone fracture continue to take drugs that increase the risk of fracture, raising questions as to why their prescriptions are not changed. The findings were published online on August 22 in JAMA Internal Medicine.
The study examined why patients who have a fragility fracture are at such high risk for subsequent fractures. Researchers conducted a retrospective cohort study from February 2015 through March 2016 of Medicare beneficiaries from 2007 through 2011. They looked at data on 168,133 patients who suffered fragility fractures during that time period, 84.2% of whom were women, and nearly 92% of whom were white.
The results suggest that more than half the patients were hospitalized as a result of their fractures, with the odds of hospitalization depending on the type of fracture. Most of the patients took a drug that was associated with an increased risk of fracture. However, when they looked at their prescription records, they found that only about 7% of these patients stopped taking drugs that were linked to an increased fracture risk.
“Exposure to prescription drugs associated with fracture risk is infrequently reduced following fragility fracture occurrence,” the researchers concluded.”While some patients eliminate their exposure to drugs associated with fracture, an equal number initiate new high-risk drugs. This pattern suggests there is a missed opportunity to modify at least one factor contributing to secondary fractures.”
A number of drugs have been linked to an increased risk of bone fractures. One of the most recent drugs associated with such risks is the diabetes drug Invokana.
Invokana (canagliflozin) was the first member of a new class of diabetes drugs, known as sodium-glucose cotransporter-2 (SGLT2) inhibitors, which was just introduced in March 2013. Invokamet is a combination therapy, including Invokana and the front-line type 2 diabetes drug metformin.
In September 2015, the FDA issued a drug safety warning that Invokana and Invokamet, a combination of Invokana and metformin, could cause weakening of bones in as little as three months after starting treatment. New bone fracture warnings were added to the drugs’ labels.
The bone fracture warnings were announced only a few months after the FDA issued a safety communication about the potential link between Invokana and ketoacidosis problems, which is a serious diabetes complications associated with increased levels of acid in the blood.