To assess the risk of hip fracture associated with the use of four classes of psychotropic drugs, we performed a case-control study of 1021 patients with hip fractures and 5606 controls among elderly Medicaid enrollees. Persons treated with hypnotics-anxiolytics having short (less than or equal to 24 hours) elimination half-lives had no increased risk of hip fracture. By contrast, a significantly increased risk was associated with current use of hypnotics-anxiolytics having long (greater than 24 hours) elimination half-lives (odds ratio, 1.8; 95 percent confidence interval, 1.3 to 2.4), tricyclic antidepressants (odds ratio, 1.9; 95 percent confidence interval, 1.3 to 2.8), and antipsychotics (odds ratio, 2.0; 95 percent confidence interval, 1.6 to 2.6). The risk increased in relation to the doses of drugs in these three classes. An analysis for possible confounding by dementia did not alter the results. Previous but noncurrent use of drugs in these classes conferred no increase in risk. Although a cause-and-effect relation was not proved, these data support the hypothesis that the sedative and autonomic effects of psychotropic drugs increase the risk of falling and fractures in elderly persons. The results suggest the need for studies of this association in other populations and for evaluation of newer psychotropic drugs with fewer undesirable sedative and autonomic effects.

Psychotropic drug use and the risk of hip fracture

https://www.archives-pmr.org/article/S0003-9993(05)00204-2/pdf

The association between psychotropic medication use and functional outcome of elderly hip-fracture patients undergoing rehabilitation.

Psychotropic drug therapy, which represents an important aspect of health promotion in the elderly, is considered to be associated with a high incidence of falls and hip fractures. In this retrospective case-control study, the interaction was tested between psychotropic drug use (short-and long-acting anxiolytics/hypnotics, antidepressants and antipsychotics), sex and hip fractures in 196 consecutive cases of community-dwelling elderly with hip fractures and 133 healthy age- and sex-matched community-residing controls. A total of 20% of the cases and 21% of the controls were receiving psycho-active medications. No association was found between fracture occurrence and use of psychotropics (p = 0.73). In addition, no significant interaction was found between sex and the incidence of fracture. Psychotropic drug use may be less important than previously assumed in connection with the occurrence of hip fractures in the elderly.

A. Adunsky

Papers

The role of psychotropic drugs in the elderly with hip fractures