Common Pain Medication May Boost Risk of Hip Fracture


New study finds drug lingers in body, making elderly more likely to take a fall. ::


A


BY CHRIS ILIADES, M.D. pain


medication could increase the risk of hip


fractures in those who are older, frail, or have kidney disease, a new study warns. Gabapentin (Neurontin)


is one of the top 10 medications prescribed in the United States. Gabapentin is FDA-


approved to treat nerve pain from shingles and restless legs syndrome. It is also used off-label by doctors to treat diabetic nerve pain, neck pain, hot flashes, anxiety, and alcohol addiction. Gabapentin is often


considered a safer choice than opioids for pain in the elderly.


HOW IT WORKS The study, published in JAMA Network Open, examined five years of hospital records of 28,000 patients over age 80 who were admitted for hip fracture. They found a 30%


higher risk of hip fracture in patients taking Neurontin. In patients also diagnosed


as frail, the risk of hip fracture increased to 75%. Patients with kidney disease were also at higher risk. “It leads to a slowing


of messaging within the brain and back and forth from brain to peripheral nerves,” explains Andrew Duxbury, M.D., professor of gerontology, geriatrics, and palliative care at the University of Alabama at Birmingham (UAB) School of Medicine. “People can feel foggy or


sleepy and not exercise best judgment.” Patients taking


Neurontin may not be able to react as quickly, so are more likely to take a fall. Frailty, a diagnosis


based on a scale called the Hospital Frailty Risk Score, means that a patient is more at risk from stress or disease. “Frailty diagnosis usually


requires a constellation of physical factors suggesting the body isn’t working as well as it once did (unable to walk quickly, get up and down from a chair easily,


losing grip strength), and physiological factors such as decline in nutrition and organ function,” explains Duxbury. Kidney disease increases


the risk of hip fracture because it allows the effects of the drug to linger. “The body uses the


kidneys as a mechanism to get rid of waste products and potentially harmful chemicals by filtering them out into the urine. If the kidneys are not


working as well, which often happens with disease processes that accompany aging, it is harder for the body to do this, so higher levels of drug can end up continuing to circulate.”


WHAT TO TAKE INSTEAD


The authors of the study recommend that patients be given a frailty assessment


before being prescribed Gabapentin. In older people,


especially those over 80 with frailty or kidney disease, other pain medication options may work as well without the risk of a fall and a hip fracture. “The mainstay of pain


relief for older people remains acetaminophen, as it is by far the safest medication out there for pain with the smallest potential side effect profile,” advises Duxbury. Most people who claim


that acetaminophen doesn’t work for them are not getting enough into their bodies to allow for consistent circulating levels, according to Duxbury. “At a minimum, I


recommend two 650 mg arthritis strength [acetaminophen] twice a day. Arthritis strength is the only formulation that is time-released, allowing for continuous circulation across an eight- to 12-hour period,” explains Duxbury. For higher pain levels,


tramadol, a non-opioid pain reliever is safe in most older people, advises Duxbury.


MARCH 2025 | NEWSMAX MAXLIFE 93


GABAPENTIN/KEMARO/SHUTTERSTOCK / HIP/RAYCAT©ISTOCK


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