Abstract
Objective
To identify the association between the use of acetylcholinesterase inhibitors (AChEIs)
and risk of osteoporotic fractures in older persons with Alzheimer's disease (AD).
Design, Setting, and Participants
A nested case-control study was conducted using the Korean National Health Insurance
Service-National Elderly Cohort database. Patients with AD who were newly diagnosed
with osteoporotic fractures were identified as cases. Up to 3 controls were matched
with cases according to age, sex, and duration of follow-up.
Methods
Participants were considered as exposed to AChEIs if they had been prescribed at least
1 AChEI during a period of 2 years before the index date. A conditional logistic regression
was performed to estimate the adjusted odds ratios with 95% confidence intervals for
the association between the use of AChEIs and osteoporotic fractures in patients with
AD. We also examined the impact of dose, duration of treatment, and timing of exposure
on the estimates of the association between the use of AChEIs and risk of osteoporotic
fractures.
Results
The study cohort comprised 45,006 patients diagnosed with AD, of which 9470 patients,
including 2385 cases and 7085 controls, were available for the study. The mean ages
(standard deviations) were 78.6 (6.9) years in the cases and 80.0 (6.9) years in the
controls. Adjusted odds ratios for the association between the use of AChEIs and osteoporotic
fractures in patients with AD was 1.18 (95% confidence interval 1.07–1.31).
Conclusions and Implications
Our data indicated that the use of AChEIs was not associated with a reduced risk of
osteoporotic fractures in patients with AD; in contrast, their use was associated
with a mild increased risk of osteoporotic fractures. Thus, clinicians should consider
the possibility of AChEIs-associated fractures among older persons with AD. Findings
of this study will support shared decision making among prescribers, patients, and
caregivers.
Keywords
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Article info
Publication history
Published online: January 13, 2020
Footnotes
D. Y. W. and S. J. B. contributed equally to this article as co-first authors.
The authors declare no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years, and no other relationships or activities that could have influenced the submitted work.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
