(168) Polypharmacy and The Risk of Fracture in Older Adults: A Systematic Review

Publication Number: 842

Background: Fractures have serious health consequences in older adults, including hospitalizations, institutionalization, and death. Many medications are individually associated with the risk of falls and, consequently, fracture. It is less clear that the use of multiple concomitant medications such as polypharmacy (≥5 medications) increases the risk of fracture.

Objectives: To identify what is known about the effect of polypharmacy on the risk of bone fracture in adults aged ≥65 years and to examine the methods used to study this effect.

Methods: We conducted a systematic literature review of studies published through June 21, 2021, in PubMed, Embase, CINAHL, PsychINFO, Cochrane, Web of science, and gray literature, regardless of language. The main concepts for the search were fractures, older adults, and polypharmacy. We screened titles, abstracts, and full texts and performed data extraction and quality assessment with two independent reviewers. We performed a narrative synthesis of the results since meta-analysis was not feasible.

Results: A total of 20 articles published between 2008 and 2021 were included. Nine different definitions of polypharmacy were used and were based on three methods of medication count (8/20 simultaneous, 4/20 cumulative, 2/20 daily average, and 6/20 indeterminate). Polypharmacy was a relevant modifiable factor in the two predictive studies included. It was prevalent among older people with a fracture and a dose-response relationship was demonstrated between increasing numbers of medications and fractures. However, only five of these studies presented multivariate analyses. Of the four articles that did not demonstrate neither a positive association between prevalent polypharmacy and fracture nor a dose-response relationship, only one included a multivariate analysis. The articles were rated from poor to acceptable quality.

Conclusions: Polypharmacy is a modifiable risk factor of interest for fractures in older adults and could contribute to quickly and easily identify individuals at risk of fracture. The diversity of methods for calculating medications and definitions of polypharmacy highlights the importance of detailed methodology for understanding and comparing results. Adjustment for confounding variables, for example with multivariate analyses, is recommended.