Falls are common amongst people aged over 65 years living in the community (> 30% per annum) and 50% of residents of aged-care facilities fall at least once a year. Up to 5% of those who fracture their hip will die in hospital, and those affected will commonly be discharged to an aged-care facility and also will have persistent mobility-related disability one year after their injury. Medicines are a modifiable risk factor for falls, with risk conferred via multiple mechanisms (e.g. drowsiness, dizziness, visual changes, confusion or orthostasis.

An Australian matched case-control study using data from the Australian Government Department of Veterans’ Affairs compared 8828 veterans with hip fracture and 35,310 matched controls of the same age and gender, exploring characteristics of medicine use during the preceding six months. Risk of hip fracture was increased for antidepressants, opioids, antiepileptic drugs, benzodiazepines and antipsychotics). The highest riskwas observed  to be aassociated with the commencement of SSRIs or opioids were started and persisted in the context of ongoing use. Co-administration of two drugs from these classes increased the risk. The greatest risk of hip fracture is observed if a benzodiazepine and an SSRI are started together (odds ratio (OR) = 4.7, 95% confidence interval (CI) 1.7–13). Adding and opioid or antipsychotic drug for people older than 80 years already using SSRIs results in an increased risk of falls and fractures. Read more about the study in the Australian Prescriber, here.