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Polypharmacy: An Unignorable Factor for Fall Injury in the Elderly

      To the Editor:
      We read with great interest the article by Sherer et al
      • Sherer JA
      • Huang Q
      • Kiel DP
      • Benjamin EJ
      • Trinquart L
      Atrial fibrillation and the risk of subsequent fracture.
      entitled “Atrial Fibrillation and the Risk of Subsequent Fracture.” This study showed the association between atrial fibrillation and increased risk of incident fracture. The relationship between atrial fibrillation and subsequent fracture has been inconclusive, and this study will add insights into that relationship. However, there is a concern that should be pointed out.
      Although this article referred to some potential confounding factors such as decreased brain perfusion, reduced bone density, and heart failure, it did not refer to the effect of polypharmacy. About 70%-80% of patients with atrial fibrillation have other comorbidities such as hypertension and diabetes mellitus.
      • Shaikh F
      • Pasch LB
      • Newton PJ
      • Bajorek BV
      • Ferguson C
      Addressing multimorbidity and polypharmacy in individuals with atrial fibrillation.
      Due to these multimorbidities, polypharmacy is a major long-time issue facing patients with atrial fibrillation.
      Polypharmacy is an established risk factor for falls in the elderly.
      • Ambrose AF
      • Cruz L
      • Paul G
      Falls and fractures: a systematic approach to screening and prevention.
      ,
      • Kojima T
      • Akishita M
      • Nakamura T
      • et al.
      Polypharmacy as a risk for fall occurrence in geriatric outpatients.
      Medications such as antihypertensive agents and diuretics, in particular, have been regarded as fall risk-increasing drugs.
      • Helgadóttir B
      • Laflamme L
      • Monárrez-Espino J
      • Möller J
      Medication and fall injury in the elderly population; do individual demographics, health status and lifestyle matter?.
      Thus, the effect of polypharmacy cannot be ignored when discussing the relationship between atrial fibrillation and subsequent fall injury. The result of this study should be interpreted carefully, considering the potential confounding effect of polypharmacy.

      References

        • Sherer JA
        • Huang Q
        • Kiel DP
        • Benjamin EJ
        • Trinquart L
        Atrial fibrillation and the risk of subsequent fracture.
        Am J Med. 2020; 133: 954-960
        • Shaikh F
        • Pasch LB
        • Newton PJ
        • Bajorek BV
        • Ferguson C
        Addressing multimorbidity and polypharmacy in individuals with atrial fibrillation.
        Curr Cardiol Rep. 2018; 20: 32
        • Ambrose AF
        • Cruz L
        • Paul G
        Falls and fractures: a systematic approach to screening and prevention.
        Maturitas. 2015; 82: 85-93
        • Kojima T
        • Akishita M
        • Nakamura T
        • et al.
        Polypharmacy as a risk for fall occurrence in geriatric outpatients.
        Geriatr Gerontol Int. 2012; 12: 425-430
        • Helgadóttir B
        • Laflamme L
        • Monárrez-Espino J
        • Möller J
        Medication and fall injury in the elderly population; do individual demographics, health status and lifestyle matter?.
        BMC Geriatr. 2014; 14: 92