Marit Stordal Bakken

Increased risk of hip fracture among older people using antidepressant drugs: data from the Norwegian Prescription Database and the Norwegian Hip Fracture Registry

BACKGROUND hip fractures are usually caused by a combination of reduced bone mineral density and falls; using antidepressant drugs may affect both of these. OBJECTIVE we aimed to examine associations between exposure to antidepressant drugs and the risk of hip fracture among older people, and, provided associations found, to estimate the attributable risk of hip fracture. DESIGN we conducted a nationwide prospective cohort study of the 906,422 people in Norway born before 1945. METHODS information on all prescriptions of antidepressants dispensed in 2004-10 and all primary hip fractures in 2005-10 was obtained from the Norwegian Prescription Database, and the Norwegian Hip Fracture Registry, respectively. The incidence rates of hip fracture during the time people were exposed and unexposed to antidepressant drugs were compared by calculating the standardised incidence ratio (SIR). RESULTS altogether 39,938 people (4.4%) experienced a primary hip fracture. The risk of hip fracture was increased for people exposed to any antidepressant [SIR = 1.7, 95% confidence interval (CI) 1.7-1.8]; tricyclic antidepressants (SIR = 1.4, 95% CI: 1.3-1.5); selective serotonin reuptake inhibitors (SSRIs) (SIR = 1.8, 95% CI: 1.7-1.8) and other antidepressants (SIR = 1.6, 95% CI: 1.5-1.7). The risk of hip fracture attributable to exposure to antidepressant drugs was 4.7%. CONCLUSIONS this study indicated an increased risk of hip fracture among people exposed to antidepressants, especially those with serotonergic properties such as SSRIs. This association needs to be explored further in clinical studies.

Inappropriate prescribing for older people admitted to an intermediate-care nursing home unit and hospital wards

Abstract Objective. To identify inappropriate prescribing among older patients on admission to and discharge from an intermediate-care nursing home unit and hospital wards, and to compare changes during stay within and between these groups. Design. Observational study. Setting and subjects. Altogether 400 community-dwelling people aged ≥ 70 years, on consecutive emergency admittance to hospital wards of internal medicine and orthopaedic surgery, were randomized to an intermediate-care nursing home unit or hospital wards; 290 (157 at the intermediate-care nursing home unit and 133 in hospital wards) were eligible for this sub-study. Main outcome measures. Prevalence on admission and discharge of potentially inappropriate medications (Norwegian general practice [NORGEP] criteria) and drug–drug interactions; changes during stay. Results. The mean (SD) age was 84.7 (6.2) years; 71% were women. From admission to discharge, the mean numbers of drugs prescribed per person increased from 6.0 (3.3) to 9.3 (3.8), p < 0.01. The prevalence of potentially inappropriate medications increased from 24% to 35%, p < 0.01; concomitant use of ≥ 3 psychotropic/opioid drugs and drug combinations including non-steroid anti-inflammatory drugs (NSAIDs) increased significantly. Serious drug–drug interactions were scarce both on admission and discharge (0.7%). Conclusions. Inappropriate prescribing was prevalent among older people acutely admitted to hospital, and the prevalence was not reduced during stay at an intermediate-care nursing home unit specially designed for these patients.

Antipsychotic Drugs and Risk of Hip Fracture in People Aged 60 and Older in Norway

To examine associations between exposure to various subgroups of antipsychotic drugs and risk of hip fracture in older adults.