Fracture risk in nursing home residents initiating antipsychotic medications. J Am Geriatr Soc 2013 May;61(5):715-22
Date
04/18/2013Pubmed ID
23590366Pubmed Central ID
PMC3656141DOI
10.1111/jgs.12216Scopus ID
2-s2.0-84877974215 (requires institutional sign-in at Scopus site) 47 CitationsAbstract
OBJECTIVES: To determine whether antipsychotic medication initiation is associated with subsequent fracture in nursing home residents, whether fracture rates differ between users of first- and second-generation antipsychotics, and whether fracture rates differ between users of haloperidol, risperidone, olanzapine, and quetiapine.
DESIGN: Time-to-event analyses were conducted in a retrospective cohort using linked Medicaid; Medicare; Minimum Data Set; and Online Survey, Certification, and Reporting data sets.
SETTING: Nursing homes in California, Florida, Missouri, New Jersey, and Pennsylvania.
PARTICIPANTS: Nursing home residents aged ≥ 65.
MEASUREMENTS: Fracture outcomes (any fracture; hip fracture) in users of first- and second-generation anti-psychotic and specifically users of haloperidol, risperidone, olanzapine, and quetiapine. Comparisons incorporated propensity scores that included individual- (demographic characteristics, comorbidity, diagnoses, weight, fall history, concomitant medications, cognitive performance, physical function, aggressive behavior) and facility- (nursing home size, ownership factors, staffing levels) level variables.
RESULTS: Of 8,262 subjects (in 4,131 pairs), 4.3% suffered any fracture during observation, with 1% having a hip fracture during an average follow-up period of 93 ± 71 days (range 1-293 days). Antipsychotic initiation was associated with any fracture (hazard ratio (HR) = 1.39, P = .004) and hip fracture (HR = 1.76, P = .02). The highest risk was found for hip fracture when antipsychotic use was adjusted for dose (HR = 2.96, P = .008), but no differences in time to fracture were found between first- and second-generation agents or between individual drugs.
CONCLUSION: Antipsychotic initiation is associated with fracture in nursing home residents, but risk does not differ between commonly used antipsychotics.
Author List
Rigler SK, Shireman TI, Cook-Wiens GJ, Ellerbeck EF, Whittle JC, Mehr DR, Mahnken JDAuthor
Jeffrey Whittle BS, MPH, MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Antipsychotic Agents
Female
Fractures, Bone
Humans
Incidence
Male
Nursing Homes
Propensity Score
Psychotic Disorders
Retrospective Studies
Risk Assessment
Risk Factors
United States
