Nerve pain drugs found to increase hip fracture risk in older adults

The use of gabapentinoids — medicines used to treat neuropathic pain — has been found to increase the risk of hip fractures, particularly in older patients who were frail or had kidney disease.

This is according to a new study by medication safety professionals at Monash University that tracked patients hospitalised for hip fractures in Victoria, Australia from March 2013 through June 2018, who had used gabapentinoids before the injury. The researchers analysed the data for 28,293 patients who experienced hip fractures across a five-year period.

Often seen as a safer alternative to opioids for the treatment of neuropathic pain, the use of the drug increased eightfold between 2012 and 2018, with one in seven Australians aged 80 and older prescribed a gabapentinoid during this period.

Currently, gabapentinoids are within the 10 most subsidised medications by volume in Australia.

While the drug can be effective for neuropathic pain, it can also result in adverse events including dizziness, gait disturbance and balance disorder, warned the study co-author and Director of the Centre for Medicine Use and Safety (CMUS) at the Monash Institute of Pharmaceutical Sciences, Professor Simon Bell.

“Our results showed patients had 30% increased odds of suffering a hip fracture within two months of being dispensed a gabapentinoid medication,” Bell said.

“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, so these should be important considerations when deciding when to prescribe gabapentinoids.”

However, Bell stressed the importance of patients discussing the issue with their doctor or pharmacist first before deciding to discontinue treatment.

Lead author of the study — published in JAMA Network Open — and CMUS PhD candidate Miriam Leung said the study highlights that caution is needed before prescribing gabapentinoids, especially for people who are prone to falls and fractures.

“Our findings highlight the importance of assessing each patient’s risk before prescribing gabapentinoids,” Leung said.

The researchers said further studies are needed to investigate the risk of hip fracture with different dosages of gabapentinoids and with different degrees of kidney impairment.

The team is currently working with the University of Eastern Finland to investigate hip fractures in patients with Parkinson’s disease.

This research was a collaboration between CMUS and researchers from Austin Health and Harvard Medical School. Data acquisition was funded via the Dementia Australia Research Foundation’s Yulgilbar Innovation Grant.

Image credit: iStock.com/Chinnapong