Antipsychotics and Hip Fracture Risk in the Elderly

Peter M. Yellowlees, MBBS, MD


November 01, 2016

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This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

Older adults are commonly prescribed antipsychotic medications that may cause a number of well-described side effects. One of the unintended consequences not frequently considered is the risk for hip fracture following a fall, which has a potentially lethal association.

Now a team of investigators from the University of Bergen in Norway have published a study examining associations between exposure to various subgroups of antipsychotic drugs and risk for hip fracture in older adults.[1] This was a nationwide cohort study of national databases and registries, including everyone living in Norway born before 1945 and alive from 2004 to 2010 (N=906,422). The investigators found that 39,984 participants (4.4%) experienced a primary hip fracture, with exposure to any antipsychotic—typical or atypical—associated with more than twice the risk for hip fracture.

It is important to note that this is an epidemiologic study from which causation cannot be directly inferred, and that there are many confounding variables that would likely reduce this level of risk at an individual level. However, these results are still of clinical importance. In these days when we try to use less restraints with behaviorally disturbed elderly patients, the results remind us that the risk of falling and breaking a hip, a potentially lethal outcome, is increased if patients are taking antipsychotic medication, however strong the indication for that medication. There is a need for further studies examining the mechanisms or causality underlying this association. In the meantime, make sure you use the smallest possible dose of antipsychotics when you have to prescribe these to your elderly patients, and try to ensure that a behavioral program is implemented at the same time.

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