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Ann Pharmacother. 2014 Aug;48(8):954-961. Epub 2014 May 9.

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

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Western University, London, ON, Canada
McMaster University, Hamilton, ON, Canada.
University of Manitoba, Winnipeg, MB, Canada.
McGill University, Montréal, QC, Canada.
University of Toronto, ON, Canada.
University of British Columbia, Vancouver, BC, Canada.
Dalhousie University, Halifax, NS, Canada.
Memorial University of Newfoundland, St John's, NL, Canada.
Queen's University, Kingston, ON, Canada.



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.


To identify the fall and fracture risk associated with ACH medication use.


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.


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.


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.


anticholinergic medications; bone mineral density; falls; fracture

Conflict of interest statement

Declaration of Conflicting Interests The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The Canadian Multicenter Osteoporosis Study is currently funded by the Canadian Institutes of Health Research (CIHR), Amgen, Merck Frosst Canada Ltd, the Dairy Farmers of Canada, Novartis, and Eli Lilly and Company. L-AF has been on the speaker’s bureau for Amgen. JDA has been on the speaker’s bureau and consultant for Amgen, Eli Lilly, Merck, Novartis, and Warner Chilcott and has done clinical trials for Amgen, Eli Lilly, Merck, and Novartis. WDL has been on the speaker’s bureau for Amgen, Eli Lilly, and Novartis and has received research grants from Amgen, Novartis, and Genzyme. CSK has been a consultant and speaker and/or received honoraria from Amgen, Danone, Eli Lilly, Merck, and Novartis. AP has been a consultant and on the speaker’s bureau for Amgen, Eli Lilly, Merck, Novartis, and Warner Chilcott and has conducted clinical trials for Eli Lilly, Merck, Novartis, and Pfizer. The other authors have no relevant conflicts of interest to declare.

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