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Research Letter
March 2015

Falls and Fractures With Atypical Antipsychotic Medication Use: A Population-Based Cohort Study

Author Affiliations
  • 1Department of Medicine, University of Western Ontario, London, Ontario, Canada
  • 2Institute for Clinical Evaluative Sciences, Western Satellite Site, London, Ontario, Canada
  • 3Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
  • 4Case Western Reserve University School of Medicine, Cleveland, Ohio
JAMA Intern Med. 2015;175(3):450-452. doi:10.1001/jamainternmed.2014.6930

Antipsychotic medications are commonly used in elderly persons to treat dementia and other behavioral disturbances.1 Several articles have linked these medications to an increased risk of fracture.2,3 It is unclear whether this fracture risk is limited to older conventional antipsychotic medications or if the risk extends to newer atypical antipsychotics4 because the newer drugs remain associated with orthostatic hypotension, gait abnormalities, and sedation (all of which may increase the risk of falling).5 We conducted a population-based study to better understand the risk of falls and fracture associated with atypical antipsychotic medications.

We used linked health care administrative databases housed at the Institute for Clinical Evaluative Sciences in the province of Ontario, Canada, which provides universal health care for its citizens. Hwang et al6 recently examined the association between the use of atypical antipsychotics and kidney injury (the study methods are fully described in that article); we used this same cohort for the current study. In brief, adults 65 years and older who received a new outpatient prescription for an oral atypical antipsychotic (quetiapine, risperidone, or olanzapine) between June 1, 2003, and December 31, 2011, were matched 1 to 1 with individuals who did not receive such a prescription. The cohort was followed up for 90 days to assess fracture and fall outcomes with hospital presentation, identified by diagnosis and procedure codes in hospital discharge, same-day surgery, and ambulatory care databases. We followed a prespecified protocol that was approved by the research ethics board at Sunnybrook Health Sciences Centre (Toronto, Ontario, Canada). Patient informed consent was not required for this study.