Association of Receiving Multiple, Concurrent Fracture-Associated Drugs With Hip Fracture Risk

Association of Receiving Multiple, Concurrent Fracture-Associated Drugs With Hip Fracture Risk

Many prescription drugs increase fracture risk, which raises concern for patients receiving 2 or more such drugs concurrently. Logic suggests that risk will increase with each additional drug, but the risk of taking multiple fracture-associated drugs (FADs) is unknown. To estimate hip fracture risk...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:JAMA network open 2019-11, Vol.2 (11), p.e1915348-e1915348
Hauptverfasser: Emeny, Rebecca T, Chang, Chiang-Hua, Skinner, Jonathan, O'Malley, A James, Smith, Jeremy, Chakraborti, Gouri, Rosen, Clifford J, Morden, Nancy E
Format: Artikel
Sprache:eng
Schlagworte:
Fractures
Geriatrics
Medicare
Narcotics
Online Only
Original Investigation
Osteoporosis
Prescription drugs
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page e1915348
container_issue 11
container_start_page e1915348
container_title JAMA network open
container_volume 2
creator Emeny, Rebecca T
Chang, Chiang-Hua
Skinner, Jonathan
O'Malley, A James
Smith, Jeremy
Chakraborti, Gouri
Rosen, Clifford J
Morden, Nancy E
description Many prescription drugs increase fracture risk, which raises concern for patients receiving 2 or more such drugs concurrently. Logic suggests that risk will increase with each additional drug, but the risk of taking multiple fracture-associated drugs (FADs) is unknown. To estimate hip fracture risk associated with concurrent exposure to multiple FADs. This cohort study used a 20% random sample of Medicare fee-for-service administrative data for age-eligible Medicare beneficiaries from 2004 to 2014. Sex-stratified Cox regression models estimated hip fracture risk associated with current receipt of 1, 2, or 3 or more of 21 FADs and, separately, risk associated with each FAD and 2-way FAD combination vs no FADs. Models included sociodemographic characteristics, comorbidities, and use of non-FAD medications. Analyses began in November 2018 and were completed April 2019. Receipt of prescription FADs. Hip fracture hospitalization. A total of 11.3 million person-years were observed, reflecting 2 646 255 individuals (mean [SD] age, 77.2 [7.3] years, 1 615 613 [61.1%] women, 2 136 585 [80.7%] white, and 219 579 [8.3%] black). Overall, 2 827 284 person-years (25.1%) involved receipt of 1 FAD; 1 322 296 (11.7%), 2 FADs; and 954 506 (8.5%), 3 or more FADs. In fully adjusted, sex-stratified models, an increase in hip fracture risk among women was associated with the receipt of 1, 2, or 3 or more FADs (1 FAD: hazard ratio [HR], 2.04; 95% CI, 1.99-2.11; P 
doi_str_mv 10.1001/jamanetworkopen.2019.15348
format Article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6902800</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2314568201</sourcerecordid><originalsourceid>FETCH-LOGICAL-a473t-a939507d3b16251d5f482f197b7b3a22cb7d2f4bafe4c298726a4e4c377440c43</originalsourceid><addsrcrecordid>eNpdkVtLxDAQhYMoKqt_QYK--GDXXJvWB2FZLyusCKL4ZkjTdM3abWrSKv57s14W9WkG5pzDzHwA7GM0xAjh47laqMZ0b84_u9Y0Q4JwPsScsmwNbBMuWEIzxNd_9VtgN4Q5QihKaZ7yTbBFsSAEUbwNHkchOG1VZ10DXQVvjTb21TYzeN3XnW1rcwTHrtG996bp4IVXuuu9SX5spoRnvp8F-GC7Jzix7UoCb2143gEblaqD2f2uA3B_cX43niTTm8ur8WiaKCZol6ic5hyJkhY4JRyXvGIZqXAuClFQRYguREkqVqjKME3yTJBUsdhSIRhDmtEBOP3KbftiYUodd_Wqlq23C-XfpVNW_p009knO3KtMc0QyhGLA4XeAdy-9CZ1c2KBNXcdnuz5IQjHjabZ84QAc_JPOXe-beJ4kaZQQnkYeA3DypdLeheBNtVoGI7kkKf-RlEuS8pNkNO_9Pmdl_eFGPwArp5_M</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2668225615</pqid></control><display><type>article</type><title>Association of Receiving Multiple, Concurrent Fracture-Associated Drugs With Hip Fracture Risk</title><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Emeny, Rebecca T ; Chang, Chiang-Hua ; Skinner, Jonathan ; O'Malley, A James ; Smith, Jeremy ; Chakraborti, Gouri ; Rosen, Clifford J ; Morden, Nancy E</creator><creatorcontrib>Emeny, Rebecca T ; Chang, Chiang-Hua ; Skinner, Jonathan ; O'Malley, A James ; Smith, Jeremy ; Chakraborti, Gouri ; Rosen, Clifford J ; Morden, Nancy E</creatorcontrib><description><![CDATA[Many prescription drugs increase fracture risk, which raises concern for patients receiving 2 or more such drugs concurrently. Logic suggests that risk will increase with each additional drug, but the risk of taking multiple fracture-associated drugs (FADs) is unknown. To estimate hip fracture risk associated with concurrent exposure to multiple FADs. This cohort study used a 20% random sample of Medicare fee-for-service administrative data for age-eligible Medicare beneficiaries from 2004 to 2014. Sex-stratified Cox regression models estimated hip fracture risk associated with current receipt of 1, 2, or 3 or more of 21 FADs and, separately, risk associated with each FAD and 2-way FAD combination vs no FADs. Models included sociodemographic characteristics, comorbidities, and use of non-FAD medications. Analyses began in November 2018 and were completed April 2019. Receipt of prescription FADs. Hip fracture hospitalization. A total of 11.3 million person-years were observed, reflecting 2 646 255 individuals (mean [SD] age, 77.2 [7.3] years, 1 615 613 [61.1%] women, 2 136 585 [80.7%] white, and 219 579 [8.3%] black). Overall, 2 827 284 person-years (25.1%) involved receipt of 1 FAD; 1 322 296 (11.7%), 2 FADs; and 954 506 (8.5%), 3 or more FADs. In fully adjusted, sex-stratified models, an increase in hip fracture risk among women was associated with the receipt of 1, 2, or 3 or more FADs (1 FAD: hazard ratio [HR], 2.04; 95% CI, 1.99-2.11; P < .001; 2 FADs: HR, 2.86; 95% CI, 2.77-2.95; P < .001; ≥3 FADs: HR, 4.50; 95% CI, 4.36-4.65; P < .001). Relative risks for men were slightly higher (1 FAD: HR, 2.23; 95% CI, 2.11-2.36; P < .001; 2 FADs: HR, 3.40; 95% CI, 3.20-3.61; P < .001; ≥3 FADs: HR, 5.18; 95% CI, 4.87-5.52; P < .001). Among women, 2 individual FADs were associated with HRs greater than 3.00; 80 pairs of FADs exceeded this threshold. Common, risky pairs among women included sedative hypnotics plus opioids (HR, 4.90; 95% CI, 3.98-6.02; P < .001), serotonin reuptake inhibitors plus benzodiazepines (HR, 4.50; 95% CI, 3.76-5.38; P < .001), and proton pump inhibitors plus opioids (HR, 4.00; 95% CI, 3.56-4.49; P < .001). Receipt of 1, 2, or 3 or more non-FADs was associated with a small, significant reduction in fracture risk compared with receipt of no non-FADs among women (1 non-FAD: HR, 0.93; 95% CI, 0.90-0.96; P < .001; 2 non-FADs: HR, 0.84; 95% CI, 0.81-0.87; P < .001; ≥3 non-FADs: HR, 0.74; 95% CI, 0.72-0.77; P < .001). Among older adults, FADs are commonly used and commonly combined. In this cohort study, the addition of a second and third FAD was associated with a steep increase in fracture risk. Many risky pairs of FADs included potentially avoidable drugs (eg, sedatives and opioids). If confirmed, these findings suggest that fracture risk could be reduced through tighter adherence to long-established prescribing guidelines and recommendations.]]></description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2019.15348</identifier><identifier>PMID: 31722031</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Fractures ; Geriatrics ; Medicare ; Narcotics ; Online Only ; Original Investigation ; Osteoporosis ; Prescription drugs</subject><ispartof>JAMA network open, 2019-11, Vol.2 (11), p.e1915348-e1915348</ispartof><rights>2019. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2019 Emeny RT et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a473t-a939507d3b16251d5f482f197b7b3a22cb7d2f4bafe4c298726a4e4c377440c43</citedby><cites>FETCH-LOGICAL-a473t-a939507d3b16251d5f482f197b7b3a22cb7d2f4bafe4c298726a4e4c377440c43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,860,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31722031$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Emeny, Rebecca T</creatorcontrib><creatorcontrib>Chang, Chiang-Hua</creatorcontrib><creatorcontrib>Skinner, Jonathan</creatorcontrib><creatorcontrib>O'Malley, A James</creatorcontrib><creatorcontrib>Smith, Jeremy</creatorcontrib><creatorcontrib>Chakraborti, Gouri</creatorcontrib><creatorcontrib>Rosen, Clifford J</creatorcontrib><creatorcontrib>Morden, Nancy E</creatorcontrib><title>Association of Receiving Multiple, Concurrent Fracture-Associated Drugs With Hip Fracture Risk</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description><![CDATA[Many prescription drugs increase fracture risk, which raises concern for patients receiving 2 or more such drugs concurrently. Logic suggests that risk will increase with each additional drug, but the risk of taking multiple fracture-associated drugs (FADs) is unknown. To estimate hip fracture risk associated with concurrent exposure to multiple FADs. This cohort study used a 20% random sample of Medicare fee-for-service administrative data for age-eligible Medicare beneficiaries from 2004 to 2014. Sex-stratified Cox regression models estimated hip fracture risk associated with current receipt of 1, 2, or 3 or more of 21 FADs and, separately, risk associated with each FAD and 2-way FAD combination vs no FADs. Models included sociodemographic characteristics, comorbidities, and use of non-FAD medications. Analyses began in November 2018 and were completed April 2019. Receipt of prescription FADs. Hip fracture hospitalization. A total of 11.3 million person-years were observed, reflecting 2 646 255 individuals (mean [SD] age, 77.2 [7.3] years, 1 615 613 [61.1%] women, 2 136 585 [80.7%] white, and 219 579 [8.3%] black). Overall, 2 827 284 person-years (25.1%) involved receipt of 1 FAD; 1 322 296 (11.7%), 2 FADs; and 954 506 (8.5%), 3 or more FADs. In fully adjusted, sex-stratified models, an increase in hip fracture risk among women was associated with the receipt of 1, 2, or 3 or more FADs (1 FAD: hazard ratio [HR], 2.04; 95% CI, 1.99-2.11; P < .001; 2 FADs: HR, 2.86; 95% CI, 2.77-2.95; P < .001; ≥3 FADs: HR, 4.50; 95% CI, 4.36-4.65; P < .001). Relative risks for men were slightly higher (1 FAD: HR, 2.23; 95% CI, 2.11-2.36; P < .001; 2 FADs: HR, 3.40; 95% CI, 3.20-3.61; P < .001; ≥3 FADs: HR, 5.18; 95% CI, 4.87-5.52; P < .001). Among women, 2 individual FADs were associated with HRs greater than 3.00; 80 pairs of FADs exceeded this threshold. Common, risky pairs among women included sedative hypnotics plus opioids (HR, 4.90; 95% CI, 3.98-6.02; P < .001), serotonin reuptake inhibitors plus benzodiazepines (HR, 4.50; 95% CI, 3.76-5.38; P < .001), and proton pump inhibitors plus opioids (HR, 4.00; 95% CI, 3.56-4.49; P < .001). Receipt of 1, 2, or 3 or more non-FADs was associated with a small, significant reduction in fracture risk compared with receipt of no non-FADs among women (1 non-FAD: HR, 0.93; 95% CI, 0.90-0.96; P < .001; 2 non-FADs: HR, 0.84; 95% CI, 0.81-0.87; P < .001; ≥3 non-FADs: HR, 0.74; 95% CI, 0.72-0.77; P < .001). Among older adults, FADs are commonly used and commonly combined. In this cohort study, the addition of a second and third FAD was associated with a steep increase in fracture risk. Many risky pairs of FADs included potentially avoidable drugs (eg, sedatives and opioids). If confirmed, these findings suggest that fracture risk could be reduced through tighter adherence to long-established prescribing guidelines and recommendations.]]></description><subject>Fractures</subject><subject>Geriatrics</subject><subject>Medicare</subject><subject>Narcotics</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Osteoporosis</subject><subject>Prescription drugs</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNpdkVtLxDAQhYMoKqt_QYK--GDXXJvWB2FZLyusCKL4ZkjTdM3abWrSKv57s14W9WkG5pzDzHwA7GM0xAjh47laqMZ0b84_u9Y0Q4JwPsScsmwNbBMuWEIzxNd_9VtgN4Q5QihKaZ7yTbBFsSAEUbwNHkchOG1VZ10DXQVvjTb21TYzeN3XnW1rcwTHrtG996bp4IVXuuu9SX5spoRnvp8F-GC7Jzix7UoCb2143gEblaqD2f2uA3B_cX43niTTm8ur8WiaKCZol6ic5hyJkhY4JRyXvGIZqXAuClFQRYguREkqVqjKME3yTJBUsdhSIRhDmtEBOP3KbftiYUodd_Wqlq23C-XfpVNW_p009knO3KtMc0QyhGLA4XeAdy-9CZ1c2KBNXcdnuz5IQjHjabZ84QAc_JPOXe-beJ4kaZQQnkYeA3DypdLeheBNtVoGI7kkKf-RlEuS8pNkNO_9Pmdl_eFGPwArp5_M</recordid><startdate>20191101</startdate><enddate>20191101</enddate><creator>Emeny, Rebecca T</creator><creator>Chang, Chiang-Hua</creator><creator>Skinner, Jonathan</creator><creator>O'Malley, A James</creator><creator>Smith, Jeremy</creator><creator>Chakraborti, Gouri</creator><creator>Rosen, Clifford J</creator><creator>Morden, Nancy E</creator><general>American Medical Association</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20191101</creationdate><title>Association of Receiving Multiple, Concurrent Fracture-Associated Drugs With Hip Fracture Risk</title><author>Emeny, Rebecca T ; Chang, Chiang-Hua ; Skinner, Jonathan ; O'Malley, A James ; Smith, Jeremy ; Chakraborti, Gouri ; Rosen, Clifford J ; Morden, Nancy E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a473t-a939507d3b16251d5f482f197b7b3a22cb7d2f4bafe4c298726a4e4c377440c43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Fractures</topic><topic>Geriatrics</topic><topic>Medicare</topic><topic>Narcotics</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Osteoporosis</topic><topic>Prescription drugs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Emeny, Rebecca T</creatorcontrib><creatorcontrib>Chang, Chiang-Hua</creatorcontrib><creatorcontrib>Skinner, Jonathan</creatorcontrib><creatorcontrib>O'Malley, A James</creatorcontrib><creatorcontrib>Smith, Jeremy</creatorcontrib><creatorcontrib>Chakraborti, Gouri</creatorcontrib><creatorcontrib>Rosen, Clifford J</creatorcontrib><creatorcontrib>Morden, Nancy E</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Emeny, Rebecca T</au><au>Chang, Chiang-Hua</au><au>Skinner, Jonathan</au><au>O'Malley, A James</au><au>Smith, Jeremy</au><au>Chakraborti, Gouri</au><au>Rosen, Clifford J</au><au>Morden, Nancy E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of Receiving Multiple, Concurrent Fracture-Associated Drugs With Hip Fracture Risk</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2019-11-01</date><risdate>2019</risdate><volume>2</volume><issue>11</issue><spage>e1915348</spage><epage>e1915348</epage><pages>e1915348-e1915348</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract><![CDATA[Many prescription drugs increase fracture risk, which raises concern for patients receiving 2 or more such drugs concurrently. Logic suggests that risk will increase with each additional drug, but the risk of taking multiple fracture-associated drugs (FADs) is unknown. To estimate hip fracture risk associated with concurrent exposure to multiple FADs. This cohort study used a 20% random sample of Medicare fee-for-service administrative data for age-eligible Medicare beneficiaries from 2004 to 2014. Sex-stratified Cox regression models estimated hip fracture risk associated with current receipt of 1, 2, or 3 or more of 21 FADs and, separately, risk associated with each FAD and 2-way FAD combination vs no FADs. Models included sociodemographic characteristics, comorbidities, and use of non-FAD medications. Analyses began in November 2018 and were completed April 2019. Receipt of prescription FADs. Hip fracture hospitalization. A total of 11.3 million person-years were observed, reflecting 2 646 255 individuals (mean [SD] age, 77.2 [7.3] years, 1 615 613 [61.1%] women, 2 136 585 [80.7%] white, and 219 579 [8.3%] black). Overall, 2 827 284 person-years (25.1%) involved receipt of 1 FAD; 1 322 296 (11.7%), 2 FADs; and 954 506 (8.5%), 3 or more FADs. In fully adjusted, sex-stratified models, an increase in hip fracture risk among women was associated with the receipt of 1, 2, or 3 or more FADs (1 FAD: hazard ratio [HR], 2.04; 95% CI, 1.99-2.11; P < .001; 2 FADs: HR, 2.86; 95% CI, 2.77-2.95; P < .001; ≥3 FADs: HR, 4.50; 95% CI, 4.36-4.65; P < .001). Relative risks for men were slightly higher (1 FAD: HR, 2.23; 95% CI, 2.11-2.36; P < .001; 2 FADs: HR, 3.40; 95% CI, 3.20-3.61; P < .001; ≥3 FADs: HR, 5.18; 95% CI, 4.87-5.52; P < .001). Among women, 2 individual FADs were associated with HRs greater than 3.00; 80 pairs of FADs exceeded this threshold. Common, risky pairs among women included sedative hypnotics plus opioids (HR, 4.90; 95% CI, 3.98-6.02; P < .001), serotonin reuptake inhibitors plus benzodiazepines (HR, 4.50; 95% CI, 3.76-5.38; P < .001), and proton pump inhibitors plus opioids (HR, 4.00; 95% CI, 3.56-4.49; P < .001). Receipt of 1, 2, or 3 or more non-FADs was associated with a small, significant reduction in fracture risk compared with receipt of no non-FADs among women (1 non-FAD: HR, 0.93; 95% CI, 0.90-0.96; P < .001; 2 non-FADs: HR, 0.84; 95% CI, 0.81-0.87; P < .001; ≥3 non-FADs: HR, 0.74; 95% CI, 0.72-0.77; P < .001). Among older adults, FADs are commonly used and commonly combined. In this cohort study, the addition of a second and third FAD was associated with a steep increase in fracture risk. Many risky pairs of FADs included potentially avoidable drugs (eg, sedatives and opioids). If confirmed, these findings suggest that fracture risk could be reduced through tighter adherence to long-established prescribing guidelines and recommendations.]]></abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>31722031</pmid><doi>10.1001/jamanetworkopen.2019.15348</doi><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2574-3805
ispartof JAMA network open, 2019-11, Vol.2 (11), p.e1915348-e1915348
issn 2574-3805
2574-3805
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6902800
source DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection
subjects Fractures
Geriatrics
Medicare
Narcotics
Online Only
Original Investigation
Osteoporosis
Prescription drugs
title Association of Receiving Multiple, Concurrent Fracture-Associated Drugs With Hip Fracture Risk
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-31T17%3A59%3A51IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Association%20of%20Receiving%20Multiple,%20Concurrent%20Fracture-Associated%20Drugs%20With%20Hip%20Fracture%20Risk&rft.jtitle=JAMA%20network%20open&rft.au=Emeny,%20Rebecca%20T&rft.date=2019-11-01&rft.volume=2&rft.issue=11&rft.spage=e1915348&rft.epage=e1915348&rft.pages=e1915348-e1915348&rft.issn=2574-3805&rft.eissn=2574-3805&rft_id=info:doi/10.1001/jamanetworkopen.2019.15348&rft_dat=%3Cproquest_pubme%3E2314568201%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2668225615&rft_id=info:pmid/31722031&rfr_iscdi=true