Blood pressure medications linked to increased risk of fractures

A Rutgers Health study found that high blood pressure medications more than doubled the risk of life-threatening bone fractures in nearly 30,000 nursing home patients.

The authors of the study, published in JAMA Internal Medicine, say the increased risk is due to the fact that these drugs impair balance, especially when patients first stand up and temporarily experience low blood pressure, which deprives the brain of oxygen. Drug interactions and low baseline balance in many nursing home patients contribute to the problem.

"Bone fractures often trigger a downward spiral in nursing home patients. Roughly 40 percent of those who break a hip die within the next year, so it's truly alarming to discover that a class of drugs used by 70 percent of all nursing home residents is more which doubles the risk of bone fractures," said Chintan Dave, academic director of the Rutgers Center for Health Outcomes, Policy and Economics and lead author of the study.

Although many patients have blood pressure so high that the benefits of treatment outweigh the dangers, "those patients need careful monitoring, especially early in treatment, and that doesn't happen," Dave said. "Nursing home staff consider blood pressure medications to be very low risk, and this is not true for this group of patients."

Dave's team analyzed Veterans Health Administration data for 29,648 elderly patients in long-term care facilities from 2006 to 2019. The researchers compared the 30-day risk of hip, pelvis, humerus, radius, or ulna fractures in patients who started using blood pressure medications with similar patients who did not use them. To maximize the likelihood that medication use rather than some other factor led to the different results, they adjusted for more than 50 baseline covariates, such as patient demographics and clinical history.

The 30-day risk of fractures for residents who started taking blood pressure medications was 5.4 per 100 people per year, and for residents who did not take blood pressure medications, the rate was 2.2 per 100 people per year.

Further analysis showed that the use of drugs particularly increased the risk of fractures in certain subgroups. Patients with dementia, a systolic pressure greater than 139 (the first number in the blood pressure reading), a diastolic pressure greater than 79 (the second number), or no recent use of blood pressure medications experienced at least a threefold risk of fractures compared with nonmedical patients.

About 2.5 million Americans live in nursing homes or assisted living facilities. Up to 50 percent of them fall within a year, and up to 25 percent of these falls result in serious injury.

Rutgers Health research shows that blood pressure medications cause many of these falls, and a combination of fewer medications and better support can significantly reduce the problem.

“Employees cannot properly assess the balance of risk and benefit unless they have accurate risk information,” Dave said. "I hope this study will provide them with information that will help them better serve their patients."