Gabapentinoids may increase hip fractures: Study

New research from Monash University has found gabapentinoids could be increasing patients’ risk of hip fractures, particularly in older people with frailty or kidney disease.
 
Published in JAMA Network Open, the study tracked 28,293 patients hospitalised for hip fractures in Victoria between March 2013 and June 2018, identifying those who had used gabapentinoids prior to their injury.
 
Ultimately, researchers found patients had 30% increased odds of a hip fracture within two months of being dispensed a gabapentinoid medication.
 
Used extensively for nerve-related pain, the gabapentinoid class of medications includes gabapentin and pregabalin, and modulates calcium channels to reduce neurotransmitter release.
 
These medications are used widely and are among the top ten most used medications on the Pharmaceutical Benefits Scheme (PBS).
 
The study’s co-author Professor Simon Bell said gabapentinoids can be effective for neuropathic pain, but can also result in adverse events including dizziness, gait disturbance and balance disorder.
 
He said the research highlights the importance of GPs tailoring decisions based on an individual’s risk profile.
 
‘The link between gabapentinoids and hip fractures existed across different age groups but the odds of hip fracture was higher among patients who were frailer or had chronic kidney disease,’ Professor Bell said.
 
‘These should be important considerations when deciding when to prescribe gabapentinoids.’
 
Each year in Australia, there are around 20,000 new hip fractures reported, with 93% the result of a fall-related injury.
 
Currently, around one in four people die within 12 months of a hip fracture injury.
 
With codeine and non-steroidal anti-inflammatory agents losing popularity with prescribers in recent years due to their potential addiction risk and significant side effect profile, gabapentinoids have been considered a safer option, increasingly filling the pain management gap. 
 
With eight times as many gabapentinoid prescriptions in 2018 compared with 2012, according to the new research, close to 15% of Australians aged over 80 have received a prescription for these medications over the same period.
 
Lead author Miriam Leung is now calling for GPs to be cautious when prescribing these medications, particularly for those at highest risk of falls and fractures.
 
‘Our findings highlight the importance of assessing each patient’s risk before prescribing gabapentinoids,’ Ms Leung said.
 
The research comes on the same day as new Australian Institute of Health and Welfare data revealed falls let to 238,055 hospitalisations in 2022–23, accounting for more than 40% of all injury hospitalisations.
 
It revealed ‘slips, trips and stumbles’ caused almost 75,000 hospitalisations in Australia in 2022–23, with falls remaining the number one cause of injury-related admissions and deaths.
 
Falls were most common among those aged 75 years and old, accounting for 46% of reported falls.
 
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