Vedelsbøl Rebekka, Anru Pavithra Laxsen, Ryg Jesper
Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.
Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
J Frailty Sarcopenia Falls. 2024 Sep 1;9(3):207-217. doi: 10.22540/JFSF-09-207. eCollection 2024 Sep.
Hip fractures (HFx) resulting from falls are a significant health concern, and drugs with anticholinergic properties (DAP) increase the risk of falls. This study aimed to assess the association between use of DAP at hospital admission and HFx risk in older patients.
This nationwide population-based study included all patients ≥65 years admitted to Danish geriatric wards during 2005-2014. Outcome of interest was first HFx within 2-years follow-up. The Anticholinergic Cognitive Burden (ACB) scale quantified DAP use. Cox regression analysis of data from four national registries was adjusted for activities of daily living, age, marital status, admission year, BMI, fracture history, previous admissions, dementia, anti-osteoporotic drugs, and Charlson comorbidity index.
74,589 patients (62.8% female) were included, 45,463 (60.9%) received DAP at index, and 7,861 HFx occurred during follow-up. Cumulative 2-year HFx hazard was highest for ACB=0 (15.3%). Higher ACB-score was not associated with increased HFx risk in univariable nor multivariable analyses. In sensitivity analysis, use of DAP with high anticholinergic burden (≥2) did not alter results.
In this high-incidence national cohort, higher ACB-score was not associated with increased HFx risk. Our results call for further research on association between specific DAP and risk of HFx.
跌倒导致的髋部骨折（HFx）是一个重大的健康问题，具有抗胆碱能特性的药物（DAP）会增加跌倒风险。本研究旨在评估老年患者入院时使用DAP与HFx风险之间的关联。
这项基于全国人口的研究纳入了2005年至2014年期间入住丹麦老年病房的所有65岁及以上患者。感兴趣的结局是2年随访期间首次发生的HFx。抗胆碱能认知负担（ACB）量表对DAP的使用进行量化。对来自四个国家登记处的数据进行Cox回归分析，并针对日常生活活动、年龄、婚姻状况、入院年份、体重指数、骨折史、既往入院情况、痴呆、抗骨质疏松药物和Charlson合并症指数进行调整。
共纳入74,589例患者（62.8%为女性），45,463例（60.9%）在索引时接受了DAP治疗，随访期间发生7,861例HFx。ACB = 0时，2年累积HFx风险最高（15.3%）。在单变量和多变量分析中，较高的ACB评分与HFx风险增加均无关联。在敏感性分析中，使用抗胆碱能负担高（≥2）的DAP并未改变结果。
在这个高发病率的全国队列中，较高的ACB评分与HFx风险增加无关。我们的结果呼吁对特定DAP与HFx风险之间的关联进行进一步研究。
