Shahar Shmuel1, Virginia Pate1, Marc J Pepin2, Janine C Bailey2, Yvonne M Golightly1,3,4,5, Laura C Hanson6,7, Til Stürmer1, Rebecca B Naumann1,3, Danijela Gnjidic8,9, Jennifer L Lund1. 1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 2. Durham VA Geriatric Research Education and Clinical Center (GRECC), Durham, North Carolina, USA. 3. Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 4. Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 5. Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 6. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 7. Division of Geriatric Medicine & Palliative Care Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 8. Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. 9. Charles Perkins Centre, University of Sydney, Sydney, Australia.
Abstract
BACKGROUND/ OBJECTIVES: Unintentional falls are a leading cause of injury for older adults, and evidence is needed to understand modifiable risk factors. We evaluated 1-year fall-related fracture risk and whether dispensing of medications with anticholinergic/sedating properties is temporally associated with an increased odds of these fractures. DESIGN: A retrospective cohort study with nested self-controlled analyses conducted between January 1, 2014, and December 31, 2016. SETTING: Twenty percent nationwide, random sample of US Medicare beneficiaries. PARTICIPANTS: New users of medications with anticholinergic/sedating properties who were 66+ years old and had Medicare Parts A, B, and D coverage but no claims for medications with anticholinergic/sedating properties in the year before initiation were eligible. MEASUREMENTS: We followed new users of medications with anticholinergic/sedating properties until first non-vertebral, fall-related fracture (primary outcome), Medicare disenrollment, death, or end of study data. We estimated the 1-year risk with corresponding 95% confidence intervals (CIs) of first fracture after new use. We applied the self-controlled case-crossover and case-time-control designs to estimate odds ratios (ORs) and 95% CIs by comparing anticholinergic and/or sedating medication exposure (any vs. none) during a 14-day hazard period preceding the fracture to exposure to these medications during an earlier 14-day control period. RESULTS: A total of 1,097,989 Medicare beneficiaries initiated medications with anticholinergic/sedating properties in the study period. The 1-year cumulative incidence of fall-related fracture, accounting for death as a competing risk, was 5.0% (95% CI: 5.0%-5.0%). Using the case-crossover design (n = 41,889), the adjusted OR for the association between anticholinergic/sedating medications and fractures was 1.03 (95% CI: 0.99, 1.08). Accounting for the noted temporal trend using the case-time-control design (n = 209,395), the adjusted OR was 1.60 (95% CI: 1.52, 1.69). CONCLUSION: Use of anticholinergic/sedating medication was temporally associated with an increased odds of fall-related fractures. Patients and their healthcare providers should consider pharmacologic and non-pharmacologic treatments for the target condition that are safer.
BACKGROUND/ OBJECTIVES: Unintentional falls are a leading cause of injury for older adults, and evidence is needed to understand modifiable risk factors. We evaluated 1-year fall-related fracture risk and whether dispensing of medications with anticholinergic/sedating properties is temporally associated with an increased odds of these fractures. DESIGN: A retrospective cohort study with nested self-controlled analyses conducted between January 1, 2014, and December 31, 2016. SETTING: Twenty percent nationwide, random sample of US Medicare beneficiaries. PARTICIPANTS: New users of medications with anticholinergic/sedating properties who were 66+ years old and had Medicare Parts A, B, and D coverage but no claims for medications with anticholinergic/sedating properties in the year before initiation were eligible. MEASUREMENTS: We followed new users of medications with anticholinergic/sedating properties until first non-vertebral, fall-related fracture (primary outcome), Medicare disenrollment, death, or end of study data. We estimated the 1-year risk with corresponding 95% confidence intervals (CIs) of first fracture after new use. We applied the self-controlled case-crossover and case-time-control designs to estimate odds ratios (ORs) and 95% CIs by comparing anticholinergic and/or sedating medication exposure (any vs. none) during a 14-day hazard period preceding the fracture to exposure to these medications during an earlier 14-day control period. RESULTS: A total of 1,097,989 Medicare beneficiaries initiated medications with anticholinergic/sedating properties in the study period. The 1-year cumulative incidence of fall-related fracture, accounting for death as a competing risk, was 5.0% (95% CI: 5.0%-5.0%). Using the case-crossover design (n = 41,889), the adjusted OR for the association between anticholinergic/sedating medications and fractures was 1.03 (95% CI: 0.99, 1.08). Accounting for the noted temporal trend using the case-time-control design (n = 209,395), the adjusted OR was 1.60 (95% CI: 1.52, 1.69). CONCLUSION: Use of anticholinergic/sedating medication was temporally associated with an increased odds of fall-related fractures. Patients and their healthcare providers should consider pharmacologic and non-pharmacologic treatments for the target condition that are safer.
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Authors: Dima M Qato; G Caleb Alexander; Rena M Conti; Michael Johnson; Phil Schumm; Stacy Tessler Lindau Journal: JAMA Date: 2008-12-24 Impact factor: 56.272
Authors: Shahar Shmuel; Virginia Pate; Marc J Pepin; Janine C Bailey; Laura C Hanson; Til Stürmer; Rebecca B Naumann; Yvonne M Golightly; Danijela Gnjidic; Jennifer L Lund Journal: Pharmacoepidemiol Drug Saf Date: 2020-10-15 Impact factor: 2.890
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