Fracture Risk in Nursing Home Residents Initiating Antipsychotic Medications. Issue 5 (16th April 2013)

• Record Type: Journal Article
• Authors: Rigler, Sally K.; Shireman, Theresa I.; Cook‐Wiens, Galen J.; Ellerbeck, Edward F.; Whittle, Jeffrey C.; Mehr, David R.; Mahnken, Jonathan D.
• Is Part Of: Journal of the American Geriatrics Society. Volume 61:Issue 5(2013:May)
• Page Start: 715
• Page End: 722
• Publication Date: 2013-04-16
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.12216
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" xml:lang="en" id="jgs12216-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs12216-sec-0001" sec-type="section"> <title>Objectives</title> <p>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.</p> </sec> <sec id="jgs12216-sec-0002" sec-type="section"> <title>Design</title> <p>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.</p> </sec> <sec id="jgs12216-sec-0003" sec-type="section"> <title>Setting</title> <p>Nursing homes in California, Florida, Missouri, New Jersey, and Pennsylvania.</p> </sec> <sec id="jgs12216-sec-0004" sec-type="section"> <title>Participants</title> <p>Nursing home residents aged ≥ 65.</p> </sec> <sec id="jgs12216-sec-0005" sec-type="section"> <title>Measurements</title> <p>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.</p> </sec> <sec id="jgs12216-sec-0006" sec-type="section"> <title>Results</title> <p>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, <italic>P</italic> = .004) and hip fracture (HR = 1.76, <italic>P</italic> = .02). The highest risk was found for hip fracture when antipsychotic use was adjusted for dose (HR = 2.96, <italic>P</italic> = .008), but no differences in time to fracture were found between first‐ and second‐generation agents or between individual drugs.</p> </sec> <sec id="jgs12216-sec-0007" sec-type="section"> <title>Conclusion</title> <p>Antipsychotic initiation is associated with fracture in nursing home residents, but risk does not differ between commonly used antipsychotics.</p> </sec> </abstract>