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J Am Geriatr Soc. 2013 May;61(5):715-22. doi: 10.1111/jgs.12216. Epub 2013 Apr 16.

Fracture risk in nursing home residents initiating antipsychotic medications.

Author information

  • 1Department of Medicine and, School of Medicine, University of Kansas, Kansas City, Kansas 66160, USA. srigler@kumc.edu

Abstract

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.

© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

PMID:
23590366
[PubMed - indexed for MEDLINE]
PMCID:
PMC3656141
Free PMC Article
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