JAMDA
Volume 11, Issue 2 , Pages 120-127 , February 2010

Antipsychotic Use and the Risk of Hip Fracture Among Older Adults Afflicted With Dementia

  • Jessica J. Jalbert, PhD Candidate

      Affiliations

    • Department of Community Health–Epidemiology, Brown University Warren Alpert Medical School, Providence, RI
    • ,
  • Charles B. Eaton, MD, MSc

      Affiliations

    • Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, RI
    • Department of Family Medicine, Brown University Warren Alpert Medical School, Providence, RI
    • ,
  • Susan C. Miller, PhD, MBA

      Affiliations

    • Center for Gerontology and Health Care Research, Brown University Warren Alpert Medical School, Providence, RI
    • ,
  • Kate L. Lapane, PhD

      Affiliations

    • Department of Community Health–Epidemiology, Brown University Warren Alpert Medical School, Providence, RI
    • Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA
    • Corresponding Author InformationAddress correspondence to Kate L. Lapane, PhD, 1008 E. Clay Street, 3rd floor, PO Box 980212, Richmond, VA, 23298.

References 

  1. Cummings JL. Alzheimer's disease. N Engl J Med. 2004;351:56–67
  2. Jalbert JJ, Daiello LA, Lapane KL. Dementia of the Alzheimer type. Epidemiol Rev. 2008;30:15–34
  3. Food and Drug Administration. Information for Healthcare Professionals: Antipsychotics. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm084149.htm. Accessed October 5, 2009.
  4. Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: Meta-analysis of randomized placebo-controlled trials. JAMA. 2005;294:1934–1943
  5. Kales HC, Valenstein M, Kim HM, et al. Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. Am J Psychiatry. 2007;164:1568–1576
  6. Schneeweiss S, Setoguchi S, Brookhart A, et al. Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients. CMAJ. 2007;176:627–632
  7. Hollis J, Grayson D, Forrester L, et al. Antipsychotic medication dispensing and risk of death in veterans and war widows 65 years and older. Am J Geriatr Psychiatry. 2007;15:932–941
  8. Trifiro G, Verhamme KM, Ziere G, et al. All-cause mortality associated with atypical and typical antipsychotics in demented outpatients. Pharmacoepidemiol Drug Saf. 2007;16:538–544
  9. Gill SS, Bronskill SE, Normand SL, et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med. 2007;146:775–786
  10. Wang PS, Schneeweiss S, Avorn J, et al. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med. 2005;353:2335–2341
  11. Liperoti R, Gambassi G, Lapane KL, et al. Cerebrovascular events among elderly nursing home patients treated with conventional or atypical antipsychotics. J Clin Psychiatry. 2005;66:1090–1096
  12. Herrmann N, Mamdani M, Lanctot KL. Atypical antipsychotics and risk of cerebrovascular accidents. Am J Psychiatry. 2004;161:1113–1115
  13. Liperoti R, Pedone C, Lapane KL, et al. Venous thromboembolism among elderly patients treated with atypical and conventional antipsychotic agents. Arch Intern Med. 2005;165:2677–2682
  14. Knol W, van Marum RJ, Jansen PA, et al. Antipsychotic drug use and risk of pneumonia in elderly people. J Am Geriatr Soc. 2008;56:661–666
  15. Ray WA, Chung CP, Murray KT, et al. Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med. 2009;360:225–235
  16. Liperoti R, Gambassi G, Lapane KL, et al. Conventional and atypical antipsychotics and the risk of hospitalization for ventricular arrhythmias or cardiac arrest. Arch Intern Med. 2005;165:696–701
  17. Straus SM, Bleumink GS, Dieleman JP, et al. Antipsychotics and the risk of sudden cardiac death. Arch Intern Med. 2004;164:1293–1297
  18. Davidson CW, Merrilees MJ, Wilkinson TJ, et al. Hip fracture mortality and morbidity—can we do better?. N Z Med J. 2001;114:329–332
  19. White BL, Fisher WD, Laurin CA. Rate of mortality for elderly patients after fracture of the hip in the 1980's. J Bone Joint Surg Am. 1987;69:1335–1340
  20. Haleem S, Lutchman L, Mayahi R, et al. Mortality following hip fracture: Trends and geographical variations over the last 40 years. Injury. 2008;39:1157–1163
  21. Morrison RS, Siu AL. Survival in end-stage dementia following acute illness. JAMA. 2000;284:47–52
  22. Morris JN, Hawes C, Fries BE, et al. Designing the national resident assessment instrument for nursing homes. Gerontologist. 1990;30:293–307
  23. Hawes C, Morris JN, Phillips CD, et al. Reliability estimates for the Minimum Data Set for nursing home resident assessment and care screening (MDS). Gerontologist. 1995;35:172–178
  24. Lawton MP, Casten R, Parmelee PA, et al. Psychometric characteristics of the minimum data set II: Validity. J Am Geriatr Soc. 1998;46:736–744
  25. Hartmaier SL, Sloane PD, Guess HA, et al. The MDS Cognition Scale: A valid instrument for identifying and staging nursing home residents with dementia using the minimum data set. J Am Geriatr Soc. 1994;42:1173–1179
  26. Gambassi G, Landi F, Peng L, et al. Validity of diagnostic and drug data in standardized nursing home resident assessments: Potential for geriatric pharmacoepidemiology. SAGE Study Group. Systematic Assessment of Geriatric drug use via Epidemiology. Med Care. 1998;36:167–179
  27. Morris JN, Nonemaker S, Murphy K, et al. A commitment to change: Revision of HCFA's RAI. J Am Geriatr Soc. 1997;45:1011–1016
  28. Hennessy S, Carson JL, Ray WA, Strom BL. Medicaid Databases. In:  Strom BL editors. Pharmacoepidemiology. 4th ed. Hoboken, NJ: John Wiley & Sons; 2005;
  29. Department of Health and Human Services. Medicaid At-A-Glance 2005: A Medicaid Information Source. Baltimore, MD: Centers for Medicare and Medicaid Services; 2005;DHHS publication no. (CMS) 11024–05
  30. McKenzie DA, Semradek J, McFarland BH, et al. The validity of Medicaid pharmacy claims for estimating drug use among elderly nursing home residents: The Oregon experience. J Clin Epidemiol. 2000;53:1248–1257
  31. Ngo DL, Marshall LM, Howard RN, et al. Agreement between self-reported information and medical claims data on diagnosed diabetes in Oregon's Medicaid population. J Public Health Manag Pract. 2003;9:542–544
  32. Federspiel CF, Ray WA, Schaffner W. Medicaid records as a valid data source: The Tennessee experience. Med Care. 1976;14:166–172
  33. Wysowski DK, Baum C. The validity of Medicaid diagnoses of hip fracture. Am J Public Health. 1993;83:770
  34. Ray WA, Griffin MR, Fought RL, Adams ML. Identification of fractures from computerized Medicare files. J Clin Epidemiol. 1992;45:703–714
  35. Matthews R, Brill I. SAS Programs to Select Controls for Matched Case-Control Studies SAS Users Group International Paper 152–130.
  36. Prescription drug coverage under Medicaid 2008. Congressional Research Service Report for Congress 2008. Hearne J (online). Available at: http://aging.senate.gov/crs/medicaid16.pdf. Accessed October 5, 2009.
  37. Clinical Guidelines on the Identification . Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. National Institutes of Health. Obes Res. 1998;6:51S–209S
  38. Katz S, Moskowitz RW, Jackson BA, et al. Studies of illness in the aged, the index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:94–99
  39. Liperoti R, Onder G, Lapane KL, et al. Conventional or atypical antipsychotics and the risk of femur fracture among elderly patients: Results of a case-control study. J Clin Psychiatry. 2007;68:929–934
  40. Pouwels S, van Staa TP, Egberts AC, et al. Antipsychotic use and the risk of hip/femur fracture: A population-based case-control study. Osteoporos Int. 2009;20:1499–1506
  41. Hugenholtz GW, Heerdink ER, van Staa TP, et al. Risk of hip/femur fractures in patients using antipsychotics. Bone. 2005;37:864–870
  42. Howard L, Kirkwood G, Leese M. Risk of hip fracture in patients with a history of schizophrenia. Br J Psychiatry. 2007;190:129–134
  43. Wang PS, Bohn RL, Glynn RJ, et al. Zolpidem use and hip fractures in older people. J Am Geriatr Soc. 2001;49:1685–1690
  44. Vestergaard P, Rejnmark L, Mosekilde L. Anxiolytics, sedatives, antidepressants, neuroleptics and the risk of fracture. Osteoporos Int. 2006;17:807–816
  45. Kolanowski A, Fick D, Waller JL, Ahern F. Outcomes of antipsychotic drug use in community-dwelling elders with dementia. Arch Psychiatr Nurs. 2006;20:217–225
  46. Takkouche B, Montes-Martinez A, Gill SS, Etminan M. Psychotropic medications and the risk of fracture: A meta-analysis. Drug Saf. 2007;30:171–184
  47. Drici MD, Priori S. Cardiovascular risks of atypical antipsychotic drug treatment. Pharmacoepidemiol Drug Saf. 2007;16:882–890
  48. Gupta S, Masand P, Madhusoodanan S. Side effects of atypical antipsychotics in the geriatric population. Current Psychosis and Therapeutics Reports. 2005;3:26–31
  49. Becker D, Liver O, Mester R, et al. Risperidone, but not olanzapine, decreases bone mineral density in female premenopausal schizophrenia patients. J Clin Psychiatry. 2003;64:761–766
  50. Meaney AM, Smith S, Howes OD, et al. Effects of long-term prolactin-raising antipsychotic medication on bone mineral density in patients with schizophrenia. Br J Psychiatry. 2004;184:503–508
  51. O'Keane V. Antipsychotic-induced hyperprolactinaemia, hypogonadism and osteoporosis in the treatment of schizophrenia. J Psychopharmacol. 2008;22:70–75
  52. Ray WA. Evaluating medication effects outside of clinical trials: new-user designs. Am J Epidemiol. 2003;158:915–920
  53. Briesacher BA, Limcangco MR, Simoni-Wastila L, et al. The quality of antipsychotic drug prescribing in nursing homes. Arch Intern Med. 2005;165:1280–1285

 Jessica Jalbert is a pre-doctoral fellow at Pfizer. Charles B. Eaton, MD, has active grants with Pfizer and Forest Pharmaceuticals and is also a consultant for Pfizer. Susan C. Miller has no conflicts of interest to declare. Kate L. Lapane, PhD had a training grant to fund predoctoral fellows at Pfizer.

PII: S1525-8610(09)00367-3

doi: 10.1016/j.jamda.2009.10.001

JAMDA
Volume 11, Issue 2 , Pages 120-127 , February 2010

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