11 Frailty and the Rate of Fractures in Patients Initiated on Antihypertensive Medication. (16th March 2021)

• Record Type: Journal Article
• Authors: Österdahl, M F; Wong, A; Douglas, I; Sinnott, S J; Smeeth, L; Williamson, E; Tomlinson, L
• Is Part Of: Age and ageing. Volume 50(2021)Supplement 1
• Page Start: i1
• Page End: i6
• Publication Date: 2021-03-16
• Subjects: Aging -- Periodicals; Geriatrics -- Periodicals; 618.97
• DOI: 10.1093/ageing/afab028.11
• Languages: English
• ISSNs: 0002-0729

Abstract

Abstract: Introduction: There is concern regarding adverse effects of antihypertensive treatment, including falls and subsequent fractures, especially hip fractures. As frailty is increasingly recognised as an important risk factor for adverse outcomes, we examined its relationship to fracture rates in older patients after starting antihypertensives. Methods: Using the Clinical Practice Research Datalink (CPRD), we identified participants over 65-years old starting a first-line antihypertensive medication. Using deficits identified in CPRD we classified patient-level frailty as "Fit", "Mild", "Moderate" or "Severe" using the Electronic Frailty Index. We calculated the rate of fractures by frailty level and fracture site, and determined the rate ratio (RR) of first fracture by frailty level, adjusting for confounding, using multivariable poisson regression. We conducted sensitivity analyses to additionally adjust for ethnicity, deprivation, and bisphosphonate use. Results: 44% of participants were classified as mildly frail or greater, but frail participants experienced 58% of all fractures, and 63% of hip fractures. The whole cohort showed a crude rate of 14.1 fractures/1000 person-years, with 4.5 hip fractures/1000 person-years. In severe frailty, this rises to 51.0 fractures/1000 person-years, and 17.7 hip fractures/1000 person-years. After adjustment for confounding, increasing frailty was associated with greater rate of any fracture, reaching RR 2.85 (95% confidence interval 2.43–3.33) for severe frailty versus fit. Results were unchanged in sensitivity analyses. Conclusions: Frailty and fracture are both common in older participants who start antihypertensive medications. Increasing frailty was positively associated with increased rates of fracture. Clinicians need awareness of this relationship to consider fracture risk assessment and prevention in these patients.