Drugs to be avoided in patients at risk of fractures

Which classes of drugs should be avoided in elderly patients because of increased risk of fractures? Does this include selective serotonin reuptake inhibitors (SSRIs) commonly used to treat depression?

Alexandra Papaioannou, MD: In terms of drugs that we want to look at, when we are doing our history, we want to think whether they are on any psychotropic drugs including opioids, SSRIs for depression, and serotonin-norepinephrine reuptake inhibitors (SNRIs), as they are also associated with both falls and fractures.

We should also review if they are on glucocorticoids. We just heard from Doctor Paul Moayyedi [see MIRCIM 2018] that proton pump inhibitors (PPIs) have an association and you might want to think about what dose they need to be on or lower the dose as well. Drugs such as antipsychotics and benzodiazepines certainly can increase the risk of falls and we really want to reevaluate that.