Two Prescription Solutions Studies Confirm Some Drugs Increase the Risk of Fractures for Seniors
Posted on: Wednesday, 18 October 2006, 09:00 CDT
IRVINE, Calif., Oct. 18 /PRNewswire/ -- Two studies performed by Prescription Solutions, a pharmacy benefit management company with extensive experience in managing prescription medications for seniors, indicate that certain drugs can increase the likelihood of falls and fractures in the elderly.
"For the elderly, falls are an especially serious health hazard. Our findings in these two studies clearly indicated that to modify risk factors for falls that can lead to fractures, medications for the elderly population need to be more appropriately prescribed and managed," said Edmund Pezalla, M.D., vice president and medical director for Prescription Solutions. "As a result of these studies, we can help educate both physicians and patients about alternatives to drugs that may increase the risk of falls and fractures and about precautions to take to minimize these accidents from happening."
According to the Centers for Disease Control, one out of three elderly people will fall annually, and 20 percent to 30 percent of those who fall suffer injuries such as hip fractures that reduce mobility and independence and increase the risk of premature death. In 2002, nearly 13,000 people aged 65 and older died from fall-related injuries.(1)
A Prescription Solutions study, presented by poster at the American Geriatrics Society 2006 Annual Scientific Meeting held May 3-7, 2006, demonstrated that older adults who were prescribed amitriptyline, an antidepressant, were 71 percent more likely to sustain a fracture as those not taking the drug. Despite recommendations against the use of amitriptyline in older adults by a U.S. consensus panel of experts,(2) this drug continues to be frequently prescribed for the elderly, potentially for its off-label use to treat other non-psychiatric conditions including insomnia, chronic and neuropathic pain, and fibromyalgia.
To compare the risk of fractures, Prescription Solutions examined health care claims data from a Medicare managed care plan, which included 5,515 matched pairs of amitriptyline-treated and control members (not taking amitriptyline) with a mean age of 76.5 years.
The study is the first large study conducted among community-dwelling elderly individuals and controlling for confounding factors that supports the Beers criteria that lists amitriptyline as a potentially inappropriate medication for use in the elderly population.(3) The Beers criteria were developed by nationally recognized experts in geriatric care, clinical pharmacology and psychopharmacology, to provide guidance for safe medication use in elderly patients. The criteria are used by physicians and pharmacists worldwide to identify medications for certain diseases or conditions that have potential risks for seniors that outweigh the potential benefits of the prescribed drugs.(4)
Another study, presented at the Academy of Managed Care Pharmacy 18th Annual Meeting and Showcase held April 5-8, 2006, looked at a class of drugs that was previously thought to be a safer alternative, only to find that this belief was not valid. A class of drugs known as benzodiazepines -- which are often used to treat insomnia -- has been demonstrated to increase the risk of falls and, similarly, of fractures by at least 50 percent.(5) Newer non-benzodiazepine drugs were considered to be a safer alternative. However, the study's findings show that seniors taking non-benzodiazepines for insomnia face the same risk of suffering a fracture as those treated with benzodiazepines.
"This information is important because a particular non-benzodiazepine, zolpidem, (marketed as Ambien(R)) may gain preferential use since benzodiazepines are excluded from Medicare Part D coverage in 2006. Additionally, zolpidem is expected to be available as a generic this year, which could encourage physicians to prescribe it," noted Pezalla. "It's important that physicians and patients know the added risk for falls and fractures and that they consider safer alternatives."
For this study, Prescription Solutions undertook a retrospective analysis using electronic pharmacy and medical claims to examine whether seniors treated for insomnia with a non-benzodiazepine were at an increased risk for fracture compared to those receiving a benzodiazepine. Elderly patients initiating the two therapies were identified and observed for six months prior to and up to six months following initiation of the therapy. After adjusting for differences in potential factors between the two drug groups that may affect the risk for fracture, the findings showed a similar risk for fracture among the elderly treated with non-benzodiazepines compared to benzodiazepine therapy -- suggesting that non-benzodiazepines may not be a safer alternative for insomnia in the elderly.
To help physicians and patients use medications safely and effectively, Prescription Solutions proactively uses several innovative programs such as online clinical reviews and prior authorization for selected medications to be sure they are prescribed appropriately for a particular patient, timely outreach to physicians and patients in situations when a person may be at risk for negative interactions due to taking multiple drugs and real-time screenings that notify pharmacists upon submission of a pharmacy claim when a drug may have complications for a particular patient (e.g., drug allergies, duplicate therapy).
About Prescription Solutions
Prescription Solutions is an innovative pharmacy benefit management company managing the prescription drug benefit of commercial, Medicare and governmental health plans, as well as those of employers and unions. Prescription Solutions serves members through a state-of-the-art mail service pharmacy in Carlsbad, California, as well as through a national network of 60,000 community pharmacies. Online information can be found at http://www.rxsolutions.com/.
1. http://www.cdc.gov/ncipc/factsheets. 2. Fick, DM, Cooper, JW, Wade, WE, Waller, JL, Maclean, JR, Beers, MH. "Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults: Results of a U.S. Consensus Panel of Experts," Archives of Internal Medicine, 2003;163:2716-2724. 3. ibid. 4. Molony, SL, "Beers' Criteria for Potentially Inappropriate Medication Use in the Elderly," Dermatology Nursing, 2004; 16 (6): 547-548. 5. Cumming RG, LeCouteur DG. "Benzodiazepines and Risk of Hip Fractures in Older People. A Review of the Evidence," CNS Drugs, 2003; 17: 825-837. Contact: Kimberly Kunody Prescription Solutions (714) 825-6863 kimberly.kunody@rxsol.com
Prescription Solutions
CONTACT: Kimberly Kunody of Prescription Solutions, +1-714-825-6863,kimberly.kunody@rxsol.com
Web site: http://www.rxsolutions.com/
Source: PRNewswire
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