Effects of anticholinergic and sedative medication use on fractures: A self-controlled design study.

Autor: Shmuel S; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Pate V; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Pepin MJ; Durham VA Geriatric Research Education and Clinical Center (GRECC), Durham, North Carolina, USA., Bailey JC; Durham VA Geriatric Research Education and Clinical Center (GRECC), Durham, North Carolina, USA., Golightly YM; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Hanson LC; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Division of Geriatric Medicine & Palliative Care Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Stürmer T; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Naumann RB; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Gnjidic D; Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.; Charles Perkins Centre, University of Sydney, Sydney, Australia., Lund JL; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2021 Nov; Vol. 69 (11), pp. 3212-3224. Date of Electronic Publication: 2021 Jul 22.
DOI: 10.1111/jgs.17377
Abstrakt: Background/objectives: Unintentional falls are a leading cause of injury for older adults, and evidence is needed to understand modifiable risk factors. We evaluated 1-year fall-related fracture risk and whether dispensing of medications with anticholinergic/sedating properties is temporally associated with an increased odds of these fractures.
Design: A retrospective cohort study with nested self-controlled analyses conducted between January 1, 2014, and December 31, 2016.
Setting: Twenty percent nationwide, random sample of US Medicare beneficiaries.
Participants: New users of medications with anticholinergic/sedating properties who were 66+ years old and had Medicare Parts A, B, and D coverage but no claims for medications with anticholinergic/sedating properties in the year before initiation were eligible.
Measurements: We followed new users of medications with anticholinergic/sedating properties until first non-vertebral, fall-related fracture (primary outcome), Medicare disenrollment, death, or end of study data. We estimated the 1-year risk with corresponding 95% confidence intervals (CIs) of first fracture after new use. We applied the self-controlled case-crossover and case-time-control designs to estimate odds ratios (ORs) and 95% CIs by comparing anticholinergic and/or sedating medication exposure (any vs. none) during a 14-day hazard period preceding the fracture to exposure to these medications during an earlier 14-day control period.
Results: A total of 1,097,989 Medicare beneficiaries initiated medications with anticholinergic/sedating properties in the study period. The 1-year cumulative incidence of fall-related fracture, accounting for death as a competing risk, was 5.0% (95% CI: 5.0%-5.0%). Using the case-crossover design (n = 41,889), the adjusted OR for the association between anticholinergic/sedating medications and fractures was 1.03 (95% CI: 0.99, 1.08). Accounting for the noted temporal trend using the case-time-control design (n = 209,395), the adjusted OR was 1.60 (95% CI: 1.52, 1.69).
Conclusion: Use of anticholinergic/sedating medication was temporally associated with an increased odds of fall-related fractures. Patients and their healthcare providers should consider pharmacologic and non-pharmacologic treatments for the target condition that are safer.
(© 2021 The American Geriatrics Society.)
Databáze: MEDLINE
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