We are grateful for the opportunity to respond to comments raised by Tomoyuki Kawada.
The studies
1
,2
referred to by Dr Kawada show a positive association between increasing frailty level
and risk of fracture. Kawada highlights differences in the reported magnitude of the
estimates of association in these studies (inter alia). These differences could be
explained by (1) differences in the populations at risk, which are not identical in
the 2 studies with systematic differences in sample selection; (2) analyses are not
identical and adjustment for confounding variables differs between these studies;
or (3) odds ratios are expected to provide more extreme estimates than relative risks.To read this article in full you will need to make a payment
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References
- Importance of frailty for association of antipsychotic drug use with risk of fracture: Cohort study using electronic health records.J Am Med Dir Assoc. 2019; 20: 1495-1501.e1
- Incidence and mortality of fractures by frailty level over 80 years of age: Cohort study using UK electronic health records.BMJ Open. 2018; 8: e018836
- Preventing fractures in elderly people.Br Med J. 2003; 327: 89-95
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Publication history
Published online: February 25, 2020
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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- Antipsychotic Drugs, Fracture Risk, and Frailty in Older PatientsJournal of the American Medical Directors AssociationVol. 21Issue 4
- PreviewI read the recent article published in this journal and written by Gafoor et al1 with great interest. The authors conducted a prospective study to evaluate the effect of first- or second-generation antipsychotic drugs on fracture risk with special reference to levels of frailty in patients aged 80 years and older. Fracture incidence increased with frailty progression, and frail patients received more frequent antipsychotic drug treatment than nonfrail patients. Adjusted rate ratios (RRs) [95% confidence intervals (CIs)] of the first and second generation antipsychotic drug exposure on the risk of any fracture were 1.24 (1.07‒1.43) and 1.12 (1.01‒1.24), respectively.
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