Abstract
AIM : PRO-OSTEO Extend 1was an osteoporosis management study at a Victorian Healthcare service. This post-hoc analysis examined comorbidities and drug-related risks for falls and osteoporosis, and analysed the accuracy of the medication subcomponent of the falls risk assessment tool used at the service. The secondary aim of this analysis was to evaluate the impact of proton pump inhibitors on the success of anti-osteoporosis therapies. Material and Methods : This analysis was part of a two year retrospective cohort study. The falls risk assessment tool medication subsection results, completed by nursing staff, were compared to scores given by the data collection pharmacist based on medical history notes using Mann-Whitney U test. The impact of proton pump inhibitors use on active osteoporosis therapy in patients admitted after a fall was analysed using the Fisher Exact test. Prevalence of medical and medication-related risk factors for osteoporosis and falls was compared between patients with fractures without osteoporosis treatment at admission and patient who were excluded from the primary study due to active osteoporosis therapy, or admission after a fall without a fracture. RESULTS : The falls risk assessment tool completion rate was approximately 80%, with accuracy below 50% P < 0.001. Medications which increase osteoporosis and falls risk were prevalent, with high use of benzodiazepines, opioids, serotonin reuptake inhibitors antidepressants and proton pump inhibitors. The impact of proton pump inhibitors carried a 14% increased relative risk of a fracture in this cohort (P = 0.218). There was also high prevalence of pre-existing fractures, pulmonary disease, heart failure and strokes in the study population. CONCLUSION : Falls risk assessment in relation to medication use is frequently inaccurate and is not done at all for a significant proportion of patients. The use proton pump inhibitors and medication-related risks for falls and osteoporosis treatment can be improved with potential for hospital pharmacists to contribute to the risk reduction strategies.
Highlights
Falls and fractures account for a large number of Emergency Department presentations across Australian hospitals, with nearly 250 hospital admissions per day for fractures alone[1]
Patients who were excluded from the primary study due to osteoporosis therapy use were included in the post-hoc analysis to determine the impact of pump inhibitors (PPIs) therapy on the success of osteoporosis treatment after a fall
The following comorbidities were more common amongst the cohort that met the exclusion criteria: prevalent fractures, chronic obstructive pulmonary disease (COPD), heart failure and cerebrovascular accident (CVA)/transient ischaemic attack (TIA), as well as medications known to increase the risk for osteoporosis and falls[16,17]
Summary
A post-hoc analysis of the osteoporosis management study was carried out to examine patients’ past medical histories for the prevalence of conditions and medications that contribute to falls and osteoporosis risk in an Australian setting, as well as to audit the use of the Peninsula Health Falls Risk Assessment Tool (FRAT)[10]. The use of such a tool by nursing staff on admission has been shown to be reliable and easy to administer in subacute settings and it is included in multiple hospital treatment pathways[10]. This analysis assessed the accuracy of use of the FRAT in relation to the medication-related falls risk assessment by nursing staff, as well as the completion rate of the FRAT among patients admitted due to falls in both the acute and subacute settings as this aspect of FRAT use has not been thoroughly reviewed in the past
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