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Fracture Risk in Nursing Home Residents Initiating Antipsychotic Medications Journal Article


Authors: Rigler, Sally K.; Shireman, Theresa I.; Cook-Wiens, Galen J; Ellerbeck, Edward F.; Whittle, Jeffrey C; Mehr, David R; Mahnken, Jonathan D.
Article Title: Fracture Risk in Nursing Home Residents Initiating Antipsychotic Medications
Alternate Title: Journal of the American Geriatrics Society
Abstract: OBJECTIVES: 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. DESIGN: 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. SETTING: Nursing homes in California, Florida, Missouri, New Jersey, and Pennsylvania. PARTICIPANTS: Nursing home residents aged ≥ 65. MEASUREMENTS: 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. RESULTS: 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. CONCLUSION: Antipsychotic initiation is associated with fracture in nursing home residents, but risk does not differ between commonly used antipsychotics.
Keywords: Humans; Aged; Aged, 80 and over; Female; Male; Retrospective Studies; Risk Factors; Antipsychotic Agents/therapeutic use; Incidence; United States/epidemiology; Risk Assessment/methods; Psychotic Disorders/drug therapy; Antipsychotic Agents; Antipsychotic Agents/adverse effects; Fractures, Bone/chemically induced; Fractures, Bone/epidemiology; Nursing Homes/statistics & numerical data; Propensity Score
Journal Title: Journal of the American Geriatrics Society
Volume: 61
Issue: 5
ISSN: 1532-5415
Publisher: Blackwell Science  
Date Published: 2013-05
Start Page: 715
End Page: 722
Language: English
Copyright Statement: © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
DOI/URL:
Identifier: PMID: 23590366 / PMCID: PMC3656141
Notes: Grant Support R01MH079221/MH/NIMH NIH HHS/United States