Gabapentinoid use may be associated with an increased risk of hip fractures in older adults, with findings suggesting a nearly twofold increase in risk, according to a recent study.

In the case-case-time-control study, published in JAMA Network Open, investigators reported an increased risk of hip fractures associated with gabapentinoid use, particularly in frail patients and those with chronic kidney disease (CKD). The study included 28,293 patients aged 50 years and older hospitalized for first hip fractures in Victoria, Australia, between 2013 and 2018.

Gabapentinoid dispensing within 60 days prior to a hip fracture was associated with a significantly increased risk of fracture (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.66–2.32). After adjusting for time trends and concomitant use of other central nervous system (CNS) medications, the risk remained elevated (OR = 1.30, 95% CI = 1.07–1.57). Subgroup analyses demonstrated higher risks in patients with a Hospital Frailty Risk Score of 5 or greater (OR = 1.75, 95% CI = 1.31–2.33) and those with CKD (OR = 2.41, 95% CI = 1.65–3.52).

Commonly prescribed for neuropathic pain, gabapentinoids are associated with CNS-related adverse effects such as dizziness and gait disturbances, which may contribute to falls. In the study, most of the patients were female (71.2%), and nearly 60% of them were aged 80 years or older. Although the investigators did not evaluate mortality, broader evidence indicated that approximately 25% of patients die within 1 year of a hip fracture, highlighting the significance of addressing risk factors such as medication use.

The findings suggested that individualized risk assessment, particularly considering frailty and CKD, is important when prescribing gabapentinoids to older adults. The results added to the existing evidence on the safety profile of gabapentinoids and pointed to potential areas for further research in vulnerable populations.

Full disclosures can be found in the published study.