Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study

Figures & data

Table 1 Characteristics of the study population

Characteristics	All 2,043, N (%)	Male 541 (26.4%), N (%)	Female 1,502 (73.6%), N (%)	P-value
Age (mean ± SD)	83.0±8.1	81.0±8.3	83.8±7.9	<0.0001
Age 60–79 years	576 (28)	183 (34)	393 (26)
Age ≥80 years	1,467 (72)	358 (66)	1,109 (74)
Type of fracturea
Cervical	1,062 (52)	272 (50)	790 (53)	0.498
Pertrochanteric	839 (41)	231 (43)	608 (40)	0.294
Subtrochanteric	141 (7)	38 (7)	103 (7)	0.644
First-year mortality
30 days	173 (8.5)	62 (11.5)	111 (7.4)	0.004
90 days	304 (14.9)	97 (17.9)	207 (13.8)	0.020
180 days	389 (19.0)	124 (22.9)	265 (17.6)	0.070
365 days	503 (24.6)	170 (31.4)	333 (22.2)	<0.0001
Length of stay (mean ± SD)	9.92±5.75	10.2±6.3	9.8±5.5	0.169

Notes: First-year mortality in hip fracture patients aged 60 years or older.

a Excluded: one patient coded as other.

Abbreviation: SD, standard deviation.

Table 2 Odds ratios (95% CI) of risk of death during the first year after hip fracture

Exposed to	Total number exposed, N (%)	30 days mortality of 173 patients (8.5%), exposed/nonexposed (%)OR (95% CI)	90 days mortality of 304 patients (14.9%), exposed/nonexposed (%)OR (95% CI)	180 days mortality of 389 patients (19.0%), exposed/nonexposed (%)OR (95% CI)	365 days mortality of 503 patients (24.6%), exposed/nonexposed (%) OR (95% CI)
1 FRIDa	249 (12.2)	7.2/8.6	14.9/14.9	21.3/18.7	26.5/24.4
		0.85 (0.51–1.42)	1.04 (0.71–1.52)	1.24 (0.88–1.74)	1.18 (0.86–1.62)
2 FRIDs	293 (14.3)	6.1/8.9	11.9/15.4	17.4/19.3	23.2/24.9
		0.66 (0.40–1.10)	0.73 (0.50–1.07)	0.86 (0.62–1.20)	0.89 (0.66–1.21)
3 FRIDs	315 (15.4)	7.9/8.6	16.2/14.6	18.4/19.2	26.7/24.2
		0.89 (0.57–1.40)	1.10 (0.79–1.53)	0.92 (0.67–1.27)	1.11 (0.84–1.48)
≥4 FRIDs	518 (25.4)	12.9/7.0	19.3/13.4	24.1/17.3	29.5/23.0
		2.01 (1.44–2.79)	1.56 (1.19–2.04)	1.54 (1.2–1.97)	1.43 (1.13–1.80)
≥5 drugs	990 (48.5)	10.5/6.6	17.7/12.3	22.2/16.0	28.7/20.8
		1.62 (1.17–2.24)	1.48 (1.15–1.91)	1.45 (1.15–1.82)	1.5 (1.21–1.85)
≥10 drugs	354 (17.3)	10.7/8.0	20.9/13.6	26.0/17.6	31.9/23.1
		1.29 (0.95–2.05)	1.72 (1.27–2.32)	1.70 (1.28–2.24)	1.62 (1.24–2.10)
≥3 psychotropicb	242 (11.8)	10.7/8.2	16.1/14.7	20.2/18.9	24.8/24.8
		1.33 (0.85–2.08)	1.09 (0.75–1.59)	1.07 (0.76–1.51)	0.98 (0.71–1.35)
Cardiovascular drugs	894 (43.8)	10.9/6.6	18.2/12.3	22.6/16.3	28.6/21.5
		1.67 (1.21–2.29)	1.55 (1.21–1.99)	1.46 (1.16–1.83)	1.43 (1.16–1.76)
Psychotropic drugs	928 (45.4)	9.6/7.5	16.6/13.5	20.7/17.7	27.2/22.5
		1.33 (0.97–1.82)	1.30 (1.02–1.67)	1.24 (0.99–1.55)	1.33 (1.08–1.63)
Sedative/hypnotic	738 (36.1)	10.0/7.6	16.5/13.9	20.3/18.3	26.8/23.4
		1.34 (0.97–1.85)	1.21 (0.93–1.56)	1.12 (0.89–1.42)	1.19 (0.96–1.48)
Antipsychotic	164 (8.0)	8.5/8.5	17.7/14.6	22.6/18.7	29.9/24.2
		1.34 (0.97–1.85)	1.26 (0.82–1.94)	1.28 (0.86–1.90)	1.37 (0.95–1.97)
Antidepressive	428 (20.9)	8.9/8.4	16.1/14.6	19.9/18.8	25.9/24.3
		1.11 (0.76–1.63)	1.18 (0.87–1.59)	1.11 (0.84–1.46)	1.14 (0.89–1.47)
Bensodiazepine	401 (19.6)	10.0/7.6	16.5/13.9	20.3/18.3	26.8/23.4
		1.41 (0.98–2.03)	1.27 (0.94–1.71)	1.20 (0.91–1.58)	1.27 (0.99–1.64)
Opioids	428 (20.9)	9.8/8.1	16.8/14.4	23.4/17.9	29.0/23.5
		1.25 (0.87–1.82)	1.22 (0.90–1.64)	1.43 (1.09–1.86)	1.37 (1.07–1.75)
Anticholinergic drugs	273 (13.4)	10.3/8.2	15.8/14.7	20.1/18.9	25.6/24.5
		1.24 (0.80–1.91)	1.05 (0.73–1.50)	1.05 (0.76–1.47)	1.03 (0.76–1.39)
Bone active drugs
Bisphosphonate	71 (3.5)	9.9/8.4	16.9/14.8	25.4/18.8	29.6/24.4
		1.18 (0.53–2.65)	1.17 (0.61–2.23)	1.48 (0.84–2.59)	1.3 (0.76–2.22)
Calcium and vitamin D supplementc	174 (9.0)	5.1/8.8	11.3/15.2	18.1/19.1	23.7/24.7
		0.58 (0.29–1.16)	0.73 (0.45–1.2)	0.97 (0.65–1.46)	0.99 (0.68–1.43)

Notes: Comparing exposure to FRIDs 6 months before hip fracture with the time of death, adjusted for age and sex.

a FRIDs and combinations.

b Combined use of three or more psychotropic drugs.

c Calcium and combinations of calcium and vitamin D.

Abbreviations: FRIDs, fall-risk-increasing drugs; OR, odds ratio; CI, confidence interval.

Figure 1 Time from hip fracture to death within 90 days (A) and 180 days (B) in patients treated with four or more FRIDs compared to patients treated with three or less FRIDs, adjusted for age, sex, and treatment with any four or more drugs.

Abbreviation: FRIDs, fall-risk-increasing drugs.