Volume 61, Issue 5 p. 715-722
Clinical Investigations

Fracture Risk in Nursing Home Residents Initiating Antipsychotic Medications

Sally K. Rigler MD, MPH

Corresponding Author

Sally K. Rigler MD, MPH

Department of Medicine and, School of Medicine, University of Kansas, Kansas City, Kansas

Address correspondence to Sally Rigler, Office of Scholarly, Academic and Research Mentoring, Mail Stop 1037, Department of Medicine, Kansas University Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160. E-mail: [email protected]Search for more papers by this author
Theresa I. Shireman PhD

Theresa I. Shireman PhD

Department of Preventive Medicine, School of Medicine, University of Kansas, Kansas City, Kansas

Search for more papers by this author
Galen J. Cook-Wiens

Galen J. Cook-Wiens

Department of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, California

Search for more papers by this author
Edward F. Ellerbeck MD, MPH

Edward F. Ellerbeck MD, MPH

Department of Preventive Medicine, School of Medicine, University of Kansas, Kansas City, Kansas

Search for more papers by this author
Jeffrey C. Whittle MD, MPH

Jeffrey C. Whittle MD, MPH

Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin

Search for more papers by this author
David R. Mehr MD, MS

David R. Mehr MD, MS

Department of Family and Community Medicine, School of Medicine, University of Missouri at Columbia, Columbia, Missouri

Search for more papers by this author
Jonathan D. Mahnken PhD

Jonathan D. Mahnken PhD

Department of Biostatistics, School of Medicine, University of Kansas, Kansas City, Kansas

Search for more papers by this author
First published: 16 April 2013
Citations: 40

Abstract

Objectives

To determine whether antipsychotic medication initiation is associated with subsequent fracture in nursing home residents, whether fracture rates differ between users of first- and second-generation antipsychotics, and whether fracture rates differ between users of haloperidol, risperidone, olanzapine, and quetiapine.

Design

Time-to-event analyses were conducted in a retrospective cohort using linked Medicaid; Medicare; Minimum Data Set; and Online Survey, Certification, and Reporting data sets.

Setting

Nursing homes in California, Florida, Missouri, New Jersey, and Pennsylvania.

Participants

Nursing home residents aged ≥ 65.

Measurements

Fracture outcomes (any fracture; hip fracture) in users of first- and second-generation anti-psychotic and specifically users of haloperidol, risperidone, olanzapine, and quetiapine. Comparisons incorporated propensity scores that included individual- (demographic characteristics, comorbidity, diagnoses, weight, fall history, concomitant medications, cognitive performance, physical function, aggressive behavior) and facility- (nursing home size, ownership factors, staffing levels) level variables.

Results

Of 8,262 subjects (in 4,131 pairs), 4.3% suffered any fracture during observation, with 1% having a hip fracture during an average follow-up period of 93 ± 71 days (range 1–293 days). Antipsychotic initiation was associated with any fracture (hazard ratio (HR) = 1.39, P = .004) and hip fracture (HR = 1.76, P = .02). The highest risk was found for hip fracture when antipsychotic use was adjusted for dose (HR = 2.96, P = .008), but no differences in time to fracture were found between first- and second-generation agents or between individual drugs.

Conclusion

Antipsychotic initiation is associated with fracture in nursing home residents, but risk does not differ between commonly used antipsychotics.