I read the recent article published in this journal and written by Gafoor et al
1
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.
I have some concerns about their study.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
- Frailty as a predictor of fractures among community-dwelling older people: A systematic review and meta-analysis.Bone. 2016; 90: 116-122
- Frailty as a predictor of future falls among community-dwelling older people: A systematic review and meta-analysis.J Am Med Dir Assoc. 2015; 16: 1027-1033
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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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- Importance of Frailty for Association of Antipsychotic Drug Use With Risk of Fracture: Cohort Study Using Electronic Health RecordsJournal of the American Medical Directors AssociationVol. 20Issue 12
- Response to Letter: Antipsychotic Drugs, Fracture Risk, and Frailty in Older PatientsJournal of the American Medical Directors AssociationVol. 21Issue 4
- PreviewWe are grateful for the opportunity to respond to comments raised by Tomoyuki Kawada. The studies1,2 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.
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