Falls, fractures up 50% in patients with new prescriptions for atypical antipsychotics.
Receiving a new prescription for an atypical antipsychotic medicine was associated with more serious falls and more fractures in a new retrospective cohort study.
Adults ages 65 and older who received a new prescription had a 53% increased risk of falling and a 50% increased risk of nonvertebral osteoporotic fracture, found the study. It was published as a research letter in JAMA Internal Medicine on Jan. 13, 2015, and was led by Lisa-Ann Fraser, MD, from the University of Western Ontario in Canada.
In the retrospective study of 200,000 residents of Ontario, whose medical records are kept in a central database, those who received a new prescription for one of three atypical antipsychotics — quetiapine (Seroquel), risperidone (Risperdal), or olanzapine (Zyprexa) — from 2003 to 2011 were matched 1:1 with other Ontario residents who didn’t receive such a prescription. Controls were matched to cases for fracture risk factors. Medical encounters over the following 90 days were analyzed for fracture and fall outcomes.
Starting atypical antipsychotics was associated with increased rates of hip fracture (odds ratio 1.67, 95% CI 1.53-1.81), nonvertebral osteoporotic fracture (OR 1.51, 95% CI 1.41-1.60), and falls (OR 1.54 95% CI 1.47-1.61). The risk of fracture and falling wasn’t related to the type of atypical medication used, the dosage, or whether the individual lived in a long-term care facility.
The raw data indicated that 7.0% of those receiving antipsychotic prescriptions experienced fractures versus 5.5% of the controls. Similarly, falls occurred in 4.4% of the antipsychotic recipients compared with 2.9% of controls.
Antipsychotic medications have been found to be associated with fracture risk in some previous studies, although the strength and nature of the link has been debated.
“Atypical antipsychotic medications have been found previously to be associated with hypotension, sedation, and gait abnormalities; therefore, it is possible that falls are the mechanism by which these drugs increase fracture risk,” researchers wrote.
The authors noted limitations to the study. It was retrospective, observational, and based on administrative records; there may also have been unmeasured confounding factors. Also, the analysis did not examine use of first-generation antipsychotic drugs.