Fracture Risk in Nursing Home Residents Initiating Antipsychotic Medications

• Autores: Sally K. Rigler, Theresa I. Shireman, Galen J. Cook Wiens, Edward F. Ellerbeck, Jeffrey C. Whittle, David R. Mehr, Jonathan Mahnken
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 61, Nº. 5, 2013, págs. 715-722
• Idioma: inglés
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• Resumen

  • 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.