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- Title
Effects of anticholinergic and sedative medication use on fractures: A self‐controlled design study.
- Authors
Shmuel, Shahar; Pate, Virginia; Pepin, Marc J.; Bailey, Janine C.; Golightly, Yvonne M.; Hanson, Laura C.; Stürmer, Til; Naumann, Rebecca B.; Gnjidic, Danijela; Lund, Jennifer L.
- Abstract
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.
- Subjects
SEDATIVES; BONE fractures; PARASYMPATHOMIMETIC agents; HEALTH outcome assessment; AGING; ACCIDENTAL falls in old age; INAPPROPRIATE prescribing (Medicine)
- Publication
Journal of the American Geriatrics Society, 2021, Vol 69, Issue 11, p3212
- ISSN
0002-8614
- Publication type
Article
- DOI
10.1111/jgs.17377