Effect of Anticholinergic Medications on Falls, Fracture Risk, and Bone Mineral Density Over a 10-Year Period. (August 2014)

• Record Type: Journal Article
• Authors: Fraser, Lisa-Ann; Adachi, Jonathan D.; Leslie, William D.; Goltzman, David; Josse, Robert; Prior, Jerilynn; Kaiser, Stephanie; Kreiger, Nancy; Kovacs, Christopher S.; Anastassiades, Tassos P.; Papaioannou, Alexandra
• Other Names: Goltzman David non-byline-author.; Kreiger Nancy non-byline-author.; Godmaire Suzanne non-byline-author.; Dumont Silvia non-byline-author.; Berger Claudie non-byline-author.; Zhou Wei non-byline-author.; Kovacs Christopher non-byline-author.; Sheppard Emma non-byline-author.; Kirkland Susan non-byline-author.; Kaiser Stephanie non-byline-author.; Stanfield Barbara non-byline-author.; Brown Jacques P. non-byline-author.; Bessette Louis non-byline-author.; Gendreau Marc non-byline-author.; Anastassiades Tassos non-byline-author.; Towheed Tanveer non-byline-author.; Matthews Barbara non-byline-author.; Josse Bob non-byline-author.; Jamal Sophie non-byline-author.; Murray Tim non-byline-author.; Gardner-Bray Barbara non-byline-author.; Adachi Jonathan D. non-byline-author.; Papaioannou Alexandra non-byline-author.; Pickard Laura non-byline-author.; Olszynski P. non-byline-author.; Davison K. Shawn non-byline-author.; Thingvold Jola non-byline-author.; Hanley David A. non-byline-author.; Allan Jane non-byline-author.; Prior Jerilynn C. non-byline-author.; Patel Millan non-byline-author.; Vigna Yvette non-byline-author.; Lentle Brian non-byline-author.;
• Is Part Of: Annals of pharmacotherapy. Volume 48:Number 8(2014:Aug.)
• Page Start: 954
• Page End: 961
• Publication Date: 2014-08
• Subjects: anticholinergic medications -- fracture -- bone mineral density -- falls; Chemotherapy -- Periodicals; Pharmacology -- Periodicals; 615.5805
• DOI: 10.1177/1060028014535363
• Languages: English
• ISSNs: 1060-0280

Abstract

Background: Many medications used in older adults have strong anticholinergic (ACH) properties, which may increase the risk of falls and fractures. Use of these medications was identified in a population-based Canadian cohort.Objective: To identify the fall and fracture risk associated with ACH medication use.Methods: Data collection and analysis were conducted at baseline, year 5, and year 10. Cross-sectional analyses were performed to examine associations between ACH medication use and falls. Time-dependent Cox regression was used to examine time to first nontraumatic fracture. Finally, change in bone mineral density (BMD) over 10 years was compared in ACH medication users versus nonusers.Results: Strongly ACH medications were used by 618 of 7753 participants (8.0%) at study baseline, 592 (9.5%) at year 5, and 334 (7.7%) at year 10. Unadjusted ACH medication use was associated with falls at baseline (odds ratio = 1.50; 95% CI = 1.14-1.98; P = 0.004), but the association was no longer significant after covariate adjustment. Similar results occurred at years 5 and 10. ACH medication use was associated with increased incident fracture risk before (hazard ratio = 1.22; CI = 1.13-1.32; P < 0.001) but not after covariate adjustment. Mean (SD) change in femoral neck BMD T -score over 10 years, in those using ACH medications at both years 0 and 5, was −0.60 (0.63) in ACH users versus −0.49 (0.45) in nonusers ( P = 0.041), but this was not significant after covariate adjustment.Conclusions: ACH medications were not found to be independently associated with an increased risk of falling, fractures, or BMD loss. Rather, factors associated with ACH medication use explained the apparent associations.