Dataset Information

Effects of anticholinergic and sedative medication use on fractures: A self-controlled design study.

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.

SUBMITTER: Shmuel S

PROVIDER: S-EPMC8595585 | biostudies-literature | 2021 Nov

REPOSITORIES: biostudies-literature

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Publications

Effects of anticholinergic and sedative medication use on fractures: A self-controlled design study.

Shmuel Shahar S Pate Virginia V Pepin Marc J MJ Bailey Janine C JC Golightly Yvonne M YM Hanson Laura C LC Stürmer Til T Naumann Rebecca B RB Gnjidic Danijela D Lund Jennifer L JL

Journal of the American Geriatrics Society 20210722 11

<h4>Background/objectives</h4>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.<h4>Design</h4>A retrospective cohort study with nested self-controlled analyses conducted between January 1, 2014, and December 31, 2016.<h4>Setti ...[more]

PMID: 34291817

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Dataset Information

Effects of anticholinergic and sedative medication use on fractures: A self-controlled design study.

Background/objectives

Design

Setting

Participants

Measurements

Results

Conclusion

Publications

Effects of anticholinergic and sedative medication use on fractures: A self-controlled design study.

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