If you or a loved one is elderly and taking the medication gabapentin (Neurontin), there is an important warning you should be aware of. It comes from a recent study published in the American Medical Association journal JAMA Network Open. The study found a 30 percent higher risk of hip fracture.
Gabapentin is a medication that was first approved as an anticonvulsant to treat certain types of seizures in 1993. Because it works by decreasing abnormal signals between nerve cells, gabapentin was found to also reduce nerve pain. In 2002, the U.S. Food and Drug Administration (FDA) approved gabapentin to treat nerve pain from shingles.
Many doctors also use gabapentin “off-label” to treat conditions not officially approved by the FDA. These conditions include diabetic nerve pain, back pain, and neck pain. It is the use of gabapentin as a pain medication that makes it among the top 10 medications prescribed in America. Many doctors consider it a safer choice than opioids for nerve pain.
What the study found
The JAMA study included more than 28,000 patients admitted to a hospital for hip fracture over a five-year period. The researchers focused on patients over age 79. The average age for a hip fracture is 80. Researchers found a 30 percent higher risk of hip fractures in the patients taking gabapentin during the two months before their fracture. They also found an even higher risk for patients taking gabapentin who were diagnosed as frail or who had kidney disease. Frailty increased hip fracture risk by 75 percent and kidney disease doubled the risk.
Gabapentin does not make bones break more easily, but it does increase the main cause of a hip fracture, which is a fall. In people over age 65, about 95 percent of hip fractures are caused by a fall. Because gabapentin causes a slowing of messaging between the brain and the body, it causes side effects including dizziness, blurred vision, and sleepiness. When you combine these side effects with other age-related risk factors like vision problems, osteoporosis, and loss of strength and balance, falls become more frequent.
Frailty, kidney disease, and other risk factors
Frailty is defined as an increased vulnerability to stress or disease. Frailty is a geriatric syndrome that affects up to 17 percent of older adults. Frailty increases the risk of falls, disability, and earlier death. It is not a normal part of aging. Symptoms include weakness, weight loss, slow or unsteady gait, and mental impairment.
Frailty can be diagnosed by a physical and mental exam. Diagnostic questionnaire scales are also used, including the Hospital Frailty Scale. The diagnosis requires a combination of factors that includes difficulty walking, getting up from a chair, losing grip strength, poor nutrition, and underlying disease.
Kidney disease increases risk because you need healthy kidneys to remove gabapentin from the blood stream. Poor kidney function means gabapentin lasts longer, can build up in the blood, and can cause more side effects. Other hip fracture risk factors include:
- Being over age 65
- Being female
- Being thin or tall
- Poor nutrition, especially lacking in calcium or vitamin D
- Not getting enough weight-bearing exercise
- Smoking or drinking alcohol
- Having arthritis or any medical condition that causes dizziness or balance problems
- Being on long-term steroids
The authors of the study concluded that gabapentin should be used with caution in elderly patients, especially those who are frail or suffer from kidney disease. The researchers note that other medications that may cause dizziness, loss of balance, or sleepiness have also been associated with a higher risk of falls and fractures. These include opioids, Parkinson’s medications, and medications given for anxiety called benzodiazepines. The authors also advise a frailty assessment before considering gabapentin.
Other options for pain
For pain control in the elderly there may be better options, especially for off-label pain control. The American Geriatrics Society recommends acetaminophen (Tylenol) as the safest option, followed by nonsteroidal anti-inflammatory drugs (NSAIDs, including Advil, Motrin, and others) and topical analgesics like an NSAID cream, capsaicin, or lidocaine. For stronger pain that does not respond to other medications, there is tramadol (ConZip), an opioid-like medication that is safer than other opioids and may be combined with acetaminophen. Because there is a strong emotional component to pain, other options may include antidepressants.
If you or a loved one has been prescribed gabapentin, ask your provider if it may increase your risk of a fall, and if there are other options to consider. Do not stop taking gabapentin on your own. Suddenly stopping gabapentin may increase the risk of a seizure. Your doctor can help you get off gabapentin gradually and find a safer alternative.
