Hip fractures were 30% more common among older people who were taking gabapentinoids.

Gabapentinoids can cause gait distur­bance, drowsiness and dizziness, which could raise risk for falls and fractures, especially among older patients. To evaluate the association between gabapentinoids and risk for hip fracture, Australian researchers used a database of linked health records to identify about 2600 patients (age, 50 years and older) hospitalised with hip fractures between 2013 and 2018 who also had prescriptions for gabapentinoids (pregabalin in 94% of cases).

The researchers used a case­crossover design (i.e. patients served as their own controls over time) to examine the temporal relationship between gabapentin exposure and hip fracture. After adjusting for comorbidities, relevant medication use (e.g. benzodiazepines, opioids) and increased gabapentinoid prescribing over time, the odds ratio for hip fracture during gabapentinoid use was 1.3. Among subgroups of patients with chronic kidney disease and frailty, the odds ratios were 2.4 and 1.8, respectively.

Comment: This study adds to growing evidence for potential harms from gabapentinoids. The high prevalence of pregabalin prescribing in this study reflects prescribing patterns in Australia, where pregabalin is much more com­monly used than gabapentin. However, given their similar side effect profiles, we can assume reasonably that gabapentin is also associated with hip fracture risk. Before I prescribe gabapentinoids, I carefully consider potential sedation and fall risk. Based on this study, I will include hip fracture risk in future discussions with patients.

Christopher W. Goodman, MD, Clinical Assistant Professor of Internal Medicine, University of South Carolina School of Medicine, Columbia, USA.

Leung MTY, et al. Gabapentinoids and risk of hip fracture. JAMA Netw Open 2024; 7: e2444488.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine.