Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan.
Department of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan.
Osteoporos Int. 2017 Apr;28(4):1167-1178. doi: 10.1007/s00198-016-3881-3. Epub 2017 Jan 12.
Our systematic review and meta-analysis of observational studies indicated that the use of antipsychotics was associated with a nearly 1.5-fold increase in the risk of fracture. First-generation antipsychotics (FGAs) appeared to carry a higher risk of fracture than second-generation antipsychotics (SGAs).
The risk of fractures associated with the use of antipsychotic medications has inconsistent evidence between different drug classes. A systematic review and meta-analysis was conducted to evaluate whether there is an association between the use of antipsychotic drugs and fractures.
Searches were conducted through the PubMed and EMBASE databases to identify observational studies that had reported a quantitative estimate of the association between use of antipsychotics and fractures. The summary risk was derived from random effects meta-analysis.
The search yielded 19 observational studies (n = 544,811 participants) with 80,835 fracture cases. Compared with nonuse, use of FGAs was associated with a significantly higher risk for hip fractures (OR 1.67, 95% CI, 1.45-1.93), and use of second generation antipsychotics (SGAs) was associated with an attenuated but still significant risk for hip fractures (OR 1.33, 95% CI, 1.11-1.58). The risk of fractures associated with individual classes of antipsychotic users was heterogeneous, and odds ratios ranged from 1.24 to 2.01. Chlorpromazine was associated with the highest risk (OR 2.01, 95% CI 1.43-2.83), while Risperidone was associated with the lowest risk of fracture (OR 1.24, 95% CI 0.95-1.83).
FGA users were at a higher risk of hip fracture than SGA users. Both FGAs and SGAs were associated with an increased risk of fractures, especially among the older population. Therefore, the benefit of the off-label use of antipsychotics in elderly patients should be weighed against any risks for fracture.
我们对观察性研究的系统评价和荟萃分析表明，使用抗精神病药与骨折风险增加近 1.5 倍相关。第一代抗精神病药（FGAs）似乎比第二代抗精神病药（SGAs）骨折风险更高。
使用抗精神病药物与骨折相关的风险在不同药物类别之间证据不一致。进行了系统评价和荟萃分析，以评估使用抗精神病药物与骨折之间是否存在关联。
通过 PubMed 和 EMBASE 数据库进行搜索，以确定报告了使用抗精神病药与骨折之间关联的定量估计的观察性研究。汇总风险来自随机效应荟萃分析。
搜索结果产生了 19 项观察性研究（n=544811 名参与者，80835 例骨折病例）。与未使用者相比，使用 FGAs 与髋部骨折风险显著增加相关（OR 1.67，95%CI，1.45-1.93），使用第二代抗精神病药（SGAs）与髋部骨折风险降低但仍显著相关（OR 1.33，95%CI，1.11-1.58）。与个体类别的抗精神病药使用者相关的骨折风险具有异质性，优势比范围为 1.24 至 2.01。氯丙嗪与最高风险相关（OR 2.01，95%CI 1.43-2.83），而利培酮与骨折风险最低相关（OR 1.24，95%CI 0.95-1.83）。
FGA 用户髋部骨折风险高于 SGA 用户。FGAs 和 SGAs 均与骨折风险增加相关，尤其是在老年人群中。因此，在老年患者中使用抗精神病药的标签外用途的益处应与骨折风险权衡。
