Gabapentinoid Use Linked to Risk of Hip Fracture

A study published in JAMA Network earlier this month investigated the relationship between the use of gabapentinoids, a class of drugs that includes pregabalin (Lyrica) and gabapentin (Neurontin), and the risk of hip fractures. Similar to previous studies linking antidepressant and benzodiazepine use to hip fractures, the research showed that gabapentinoid use was also associated with in elevated risk of hip fractures among older adults, especially in those identified as frail or with chronic kidney disease. First author Miriam T. Y. Leung, M.Clin.Pharm., of Monash University in Melbourne, Australia, and her co-authors emphasized the need for cautious prescribing of gabapentinoids among vulnerable populations who are susceptible to increased adverse effects.

Gabapentinoids are commonly prescribed for conditions such as neuropathic pain, seizures and anxiety disorders. There have been dramatic increases in the prescribing and dispensing of Neurontin in the U.S. and Australia in the last decade, due in large part to it being seen as a safer alternative to opioids for pain management.But gabapentinoids have central nervous system (CNS) side effects, such as dizziness and gait disturbances, which may increase the risk of falls and, consequently, hip fractures.

Leung and her colleagues research utilized a case-case-time-control study design, focusing on patients hospitalized for hip fractures in Victoria, Australia, between March 1, 2013, and June 30, 2018. The study included patients aged 50 years and older who were admitted for their first hip fracture.Data was extracted from four linked administrative datasets, including hospitalization records and medication dispensing data.

Out of the 28,293 patients hospitalized with hip fractures, 2,946 patients were prescribed d a gabapentinoid before their fracture. After being excluded for a various variety, such as incomplete data, 2,644 patients were included in the analysis. Of those selected for analysis, more than 70% were femaleand almost 60% were older than 80.

There was a notable increased risk of hip fracture among those prescribed a gabapentinoid, and the risk was especially pronounced in patients who were frail or had CKD. Frail individuals are more likely to experience falls due to muscle weakness, poor coordination, and balance issues. Similarly, patients with CKD may have altered pharmacokinetics, increasing the likelihood of adverse effects from medications. The American Geriatrics Society Beers Criteria does recommend a dosage adjustment based on kidney function status.

Although the study did not probe deeply into age-related risks, older adults are particularly susceptible to hip fractures, and this population may need extra caution when using gabapentinoids.

One limitation the authors noted was that gabapentinoids may have a long-term adverse effect on calcium homeostasis and bone health.They suggest that their research may underestimate the overall effect of gabapentinoids on hip fractures.

The chief takeaway from the study is that managed care organizations and healthcare providers must carefully weigh the benefits of gabapentinoid use against the potential risks in populations more prone to falls and fractures.