Eldercare clinicians should exercise caution when prescribing more than one medication for fracture, especially when use is discretionary, alternatives exist, or baseline fracture risk is high, a new study has revealed.

Older Americans are commonly prescribed multiple fracture-related medications, according to an analysis of Medicare data. And taking two or more of these drugs is associated with a more than two-fold increase in hip fracture risk. In fact, some combinations appeared to be especially hazardous, the researchers wrote. 

Combinations strongly linked to fracture included opioids and sedatives, opioids and diuretics, and opioids and proton pump inhibitors (used to treat stomach acid and gastrointestinal reflux disease). Notably, many were potentially avoidable drugs, the authors reported.

The link between these drug combinations and hip fracture was stronger than expected, said lead author Rebecca Emeny, Ph.D., MPH, from The Dartmouth Institute for Health Policy and Clinical Practice. “This is an important consideration for patients, if any of their medications are optional and thus can be eliminated with no negative consequences,” she concluded.

Findings were published in JAMA Network Open.