Fracture risk in older adults peaks before gabapentinoid treatment begins, not after, suggesting the underlying condition—not the medication—drives injury risk. Careful medication review at initiation remains essential, particularly when sedating drugs are combined.
Key Points
- Fracture risk highest before treatment initiation, declines after
- Gabapentinoids alone do not sustain elevated fracture risk
- Concurrent opioids and benzodiazepines substantially increase fracture danger
Longevity Analysis
This finding reframes a common clinical assumption: the symptoms prompting gabapentinoid use carry greater fracture risk than the medication itself. The pattern reflects how untreated pain, neuropathy, or anxiety destabilizes balance, proprioception, and decision-making—the precursors to falls. The critical intervention window is medication initiation, where polypharmacy decisions determine whether sedation accumulates and balance deteriorates further. Clinicians can optimize outcomes by identifying and eliminating redundant sedating agents before starting gabapentinoids, rather than reflexively restricting the drug itself.
Original published by The Lancet Healthy Longevity, by Andrew S C Yuen, Boqing Chen, Adrienne Y L Chan, Bin Hong, Ju Hwan Kim, Joseph F Hayes, David P J Osborn, Frank M C Besag, Robert Howard, Matthew G Wilson, Wallis C Y Lau, Ian C K Wong, Li Wei, Ju-Young Shin, Kenneth K C Man.