Gabapentinoids may increase hip fracture risk in older adults

The research, published today in JAMA network openedfollowed patients hospitalized for hip fractures in Victoria, Australia from March 2013 through June 2018, who had used gabapentinoids before the injury.

Often seen as a safer alternative to opioids for the treatment of neuropathic pain, gabapentinoid use increased eightfold between 2012 and 2018, with one in seven Australians aged 80 and over prescribed a gabapentinoid during this period.

Currently, gabapentinoids are among the ten most subsidized drugs in Australia by volume.

Professor Simon Bell, co-author of the study and director of the Center for Medicine Use and Safety (CMUS) at the Monash Institute of Pharmaceutical Sciences, said gabapentinoids may be effective for neuropathic pain but can also lead to side effects including dizziness , gait disorders and balance disorder.

The researchers analyzed data from 28,293 patients who had suffered hip fractures over a five-year period.

Our results showed that patients were 30 percent more likely to experience a hip fracture within two months of receiving a gabapentinoid drug.

The association between gabapentinoids and hip fracture existed across different age groups, but the risk of hip fracture was greater in patients who were more frail or had chronic kidney disease, so these should be important considerations when deciding when to prescribe gabapentinoids.”

Professor Simon Bell, Director of the Center for Medicine Use and Safety (CMUS), Monash Institute of Pharmaceutical Sciences

However, Professor Bell stressed the importance of patients speaking to their doctor or pharmacist before deciding to discontinue treatment.

This is the first study to specifically observe a higher risk of hip fracture in frail patients receiving gabapentinoids than in non-frail patients.

Lead author of the study and CMUS PhD student Miriam Leung said the study highlights the need for caution when prescribing gabapentinoids, especially for people prone to falls and fractures.

“Our findings highlight the importance of assessing each patient’s risk before prescribing gabapentinoids,” Ms Leung said.

The researchers said further research is needed to investigate the risk of hip fracture at different doses of gabapentinoids and at different degrees of renal impairment.

The researchers are currently working with the University of Eastern Finland to investigate hip fractures in patients with Parkinson’s disease.

This study was a collaboration between CMUS and researchers from Austin Health and Harvard Medical School. The data acquisition was funded through the Dementia Australia Research Foundation’s Yulgilbar Innovation Grant.

Director of the Center for Medicine Use and Safety and co-author of the article, Professor Simon Bell, is available for interviews.