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) 41 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 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
