Ray W A, Griffin M R, Schaffner W, Baugh D K, Melton L J
N Engl J Med. 1987 Feb 12;316(7):363-9. doi: 10.1056/NEJM198702123160702.
To assess the risk of hip fracture associated with the use of four classes of psychotropic drugs, we performed a case-control study of 1021 patients with hip fractures and 5606 controls among elderly Medicaid enrollees. Persons treated with hypnotics-anxiolytics having short (less than or equal to 24 hours) elimination half-lives had no increased risk of hip fracture. By contrast, a significantly increased risk was associated with current use of hypnotics-anxiolytics having long (greater than 24 hours) elimination half-lives (odds ratio, 1.8; 95 percent confidence interval, 1.3 to 2.4), tricyclic antidepressants (odds ratio, 1.9; 95 percent confidence interval, 1.3 to 2.8), and antipsychotics (odds ratio, 2.0; 95 percent confidence interval, 1.6 to 2.6). The risk increased in relation to the doses of drugs in these three classes. An analysis for possible confounding by dementia did not alter the results. Previous but noncurrent use of drugs in these classes conferred no increase in risk. Although a cause-and-effect relation was not proved, these data support the hypothesis that the sedative and autonomic effects of psychotropic drugs increase the risk of falling and fractures in elderly persons. The results suggest the need for studies of this association in other populations and for evaluation of newer psychotropic drugs with fewer undesirable sedative and autonomic effects.
为评估使用四类精神药物与髋部骨折风险之间的关联，我们对老年医疗补助计划参保者中的1021例髋部骨折患者和5606例对照者进行了一项病例对照研究。使用消除半衰期短（小于或等于24小时）的催眠 - 抗焦虑药物治疗的患者，髋部骨折风险并未增加。相比之下，目前使用消除半衰期长（大于24小时）的催眠 - 抗焦虑药物（比值比为1.8；95%置信区间为1.3至2.4）、三环类抗抑郁药（比值比为1.9；95%置信区间为1.3至2.8）和抗精神病药物（比值比为2.0；95%置信区间为1.6至2.6），会使风险显著增加。这三类药物的风险随剂量增加而升高。对痴呆可能造成的混杂因素进行的分析并未改变研究结果。既往而非目前使用这些类别药物不会增加风险。虽然未证实存在因果关系，但这些数据支持这样的假设，即精神药物的镇静和自主神经效应会增加老年人跌倒和骨折的风险。研究结果表明需要在其他人群中对这种关联进行研究，并对具有较少不良镇静和自主神经效应的新型精神药物进行评估。
