Department of Medicine and, School of Medicine, University of Kansas, Kansas City, Kansas 66160, USA.
J Am Geriatr Soc. 2013 May;61(5):715-22. doi: 10.1111/jgs.12216. Epub 2013 Apr 16.
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.
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.
Nursing homes in California, Florida, Missouri, New Jersey, and Pennsylvania.
Nursing home residents aged ≥ 65.
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.
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.
Antipsychotic initiation is associated with fracture in nursing home residents, but risk does not differ between commonly used antipsychotics.
确定抗精神病药物的起始使用是否与养老院居民随后发生骨折有关，第一代和第二代抗精神病药物使用者的骨折发生率是否存在差异，以及使用氟哌啶醇、利培酮、奥氮平、喹硫平的患者的骨折发生率是否存在差异。
使用链接的医疗补助、医疗保险、最低数据集合和在线调查、认证和报告数据集进行回顾性队列的时间事件分析。
加利福尼亚州、佛罗里达州、密苏里州、新泽西州和宾夕法尼亚州的养老院。
年龄≥65 岁的养老院居民。
第一代和第二代抗精神病药物使用者（包括氟哌啶醇、利培酮、奥氮平、喹硫平的具体使用者）以及任何骨折和髋部骨折的骨折结局。比较纳入了个体水平（人口统计学特征、合并症、诊断、体重、跌倒史、伴随药物、认知表现、身体功能、攻击性行为）和设施水平（养老院规模、所有权因素、人员配备水平）的倾向评分。
在 8262 名受试者（4131 对）中，4.3%的患者在观察期间发生任何骨折，1%的患者在平均 93±71 天（范围 1-293 天）的随访期间发生髋部骨折。抗精神病药物起始使用与任何骨折（风险比（HR）=1.39，P=0.004）和髋部骨折（HR=1.76，P=0.02）相关。当根据剂量调整抗精神病药物使用时，发现髋部骨折的风险最高（HR=2.96，P=0.008），但第一代和第二代药物之间或个别药物之间的骨折时间无差异。
抗精神病药物起始使用与养老院居民的骨折相关，但常用抗精神病药物之间的风险无差异。
