This case–control study showed that current use of conventional antipsychotics, but not atypical antipsychotics, seems to be associated with an increased risk of a hip/femur fracture, possibly related to the pharmacological properties of conventional antipsychotics. Furthermore, no evidence for a dose effect was found.
The aim of this study was to assess the risk of hip/femur fracture associated with antipsychotic use, with particular reference to any difference in risk with conventional versus atypical antipsychotics, dose, and pharmacological properties.
A case–control study was conducted using data from the PHARMO Record Linkage System among individuals aged 18 years and older between 1991 and 2002. Cases had a record of a hip or femur fracture, while controls had no evidence of ever having sustained any fracture.
Most cases were elderly (77.6% aged ≥70 years). We found an increased risk for hip/femur fracture associated with the use of antipsychotic drugs. The risk for current users (ORadj 1.68 [1.43, 1.99]) was significantly greater than with past use (ORadj 1.33 [1.14, 1.56]; p = 0.036). Current use of conventional antipsychotics (ORadj 1.76 [1.48, 2.08]) but not atypical antipsychotics (ORadj 0.83 [0.42, 1.65]) was associated with an increased risk. We did not find evidence for a dose effect.
The use of conventional, but not atypical antipsychotics, seems to be associated with an increased risk of hip/femur fracture, possibly related to the pharmacological properties of conventional antipsychotics. However, the numbers of atypical antipsychotic users were small, and therefore this observation needs further attention in other study populations.
Rang HP et al (1999) Pharmacology, 4th edn. Churchill Livingstone, Edinburgh
Van de Kar LD et al (2001) 5-HT2A receptors stimulate ACTH, corticosterone, oxytocin, renin, and prolactin release and activate hypothalamic CRF and oxytocin-expressing cells. J Neurosci 21(10):3572–3579 PubMed
Cumming RG, Klineberg RJ (1993) Psychotropics, thiazide diuretics and hip fractures in the elderly. Med J Aust 158(6):414–417 PubMed
Ray WA et al (1987) Psychotropic drug use and the risk of hip fracture. N Engl J Med 316(7):363–369 PubMed
Sernbo I, Hansson A, Johnell O (1987) Drug consumption in patients with hip fractures compared with controls. Compr Gerontol [A] 1(3):93–96
Buurma H et al (2008) Prevalence and determinants of pharmacy shopping behaviour. J Clin Pharm Ther 33(1):17–23 PubMed
de Vries F et al (2007) Use of inhaled and oral glucocorticoids, severity of inflammatory disease and risk of hip/femur fracture: a population-based case–control study. J Intern Med 261(2):170–177 PubMed
WHO (2005) WHO Collaborating Centre for drug statistics methodology. The ATC/DDD system. World Health Organisation
Koda-Kimble MA, Young LY, Kradjan WA (2003) Applied therapeutics: the clinical use of drugs, 7th edn. . Lippincott, Williams & Wilkins, New York
Speight TM, Holford NHG (1997) Avery’s drug treatment: A guide to the properties, choice, therapeutic use and economic value of drugs in disease management, 4th edn. Adis Press, Auckland
AMAM (1996) American Medical Association. Division of Drugs and Toxicology. Drug Evaluations Annual, Chicago
Warrel DA, Cox TM, Firth JD (2005) Oxford textbook of medicine, vol. 3. 4th edn. Oxford University Press, Oxford
Grisso JA, Capezuti E, Schwartz A (1996) Falls as risk factors for fractures. In: Marcus D, Kelsey J, Feldman D (eds) Osteoporosis. Academic, San Diego, pp 599–611
Owens DC (1999) A guide to the extrapyramidal side-effects of antipsychotic drugs. Cambridge University Press, Cambridge
Melton LJ III et al (1994) Fracture risk in patients with Alzheimer’s disease. J Am Geriatr Soc 42:614–619 PubMed
- Antipsychotic use and the risk of hip/femur fracture: a population-based case–control study
T. P. van Staa
A. C. G. Egberts
H. G. M. Leufkens
F. de Vries
Neu im Fachgebiet Orthopädie und Unfallchirurgie
e.Med Kampagnen-Visual, Mail Icon II