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Importance of Frailty for Association of Antipsychotic Drug Use With Risk of Fracture: Cohort Study Using Electronic Health Records

Gafoor, R; Charlton, J; Ravindrarajah, R; Gulliford, MC; (2019) Importance of Frailty for Association of Antipsychotic Drug Use With Risk of Fracture: Cohort Study Using Electronic Health Records. Journal of the American Medical Directors Association , 20 (12) 1495-1501.e1. 10.1016/j.jamda.2019.05.009. Green open access

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Abstract

Objective: To evaluate association of first- or second-generation antipsychotic (AP) drugs with fracture risk at different levels of frailty over the age of 80 years. / Design: Population-based cohort study. / Setting and Participants: United Kingdom Clinical Practice Research Datalink including 153,304 patients aged 80 years and older between 2006 and 2015. / Methods: Rates of fracture and adjusted rate ratios (RR) were estimated by AP drug exposure category, adjusting for age, sex, frailty, number of deficits, and dementia diagnosis. / Results: Data were analyzed for 165,726 treatment episodes (153,304 patients; 61.3% women; mean age 83 years; 21,365 fractures; 681,221.1 person-years of follow-up). AP exposure was associated with increasing age, frailty, and dementia diagnosis. After adjusting for frailty and covariates, first-generation AP exposure was associated with risk of any fracture, RR 1.24 (95% confidence interval 1.07–1.43, P = .003). Second-generation AP exposure was associated with femur fracture (RR 1.41, 1.22–1.64, P < .001) but less strongly with any fracture (RR 1.12, 1.01–1.24, P = .033). Fracture incidence increased with frailty level. The number of person-years of first-generation AP treatment associated with 1 additional fracture at any site was 75 (42–257) for severely frail patients but 187 (95% confidence interval 104–640) for ‘fit’ patients. For second-generation AP, 1 additional femur fracture might result from 173 (111–323) person-years treatment in severe frailty but 365 (234–681) person-years treatment for ‘fit’ patients. / Conclusions and Implications: Frail patients are more likely to receive AP drug treatment, but their absolute risk of AP-associated fracture is substantially greater than for nonfrail patients.

Type: Article
Title: Importance of Frailty for Association of Antipsychotic Drug Use With Risk of Fracture: Cohort Study Using Electronic Health Records
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jamda.2019.05.009
Publisher version: https://doi.org/10.1016/j.jamda.2019.05.009
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Fractures, bone, frailty, antipsychotic agents, primary care, electronic health records, dementia
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Applied Health Research
URI: https://discovery.ucl.ac.uk/id/eprint/10073640
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