title: Fracture risk in nursing home residents initiating antipsychotic medications.
abstract: OBJECTIVE
  To determine whether antipsychotic medication initiation is associated with subsequent fracture in nursing home residents, whether fracture rates differ between users of first- and second-generation antipsychotics, and whether fracture rates differ between users of haloperidol, risperidone, olanzapine, and quetiapine.
  
  
  METHODS
  Time-to-event analyses were conducted in a retrospective cohort using linked Medicaid; Medicare; Minimum Data Set; and Online Survey, Certification, and Reporting data sets.
  
  
  METHODS
  Nursing homes in California, Florida, Missouri, New Jersey, and Pennsylvania.
  
  
  METHODS
  Nursing home residents aged ≥ 65.
  
  
  METHODS
  Fracture outcomes (any fracture; hip fracture) in users of first- and second-generation anti-psychotic and specifically users of haloperidol, risperidone, olanzapine, and quetiapine. Comparisons incorporated propensity scores that included individual- (demographic characteristics, comorbidity, diagnoses, weight, fall history, concomitant medications, cognitive performance, physical function, aggressive behavior) and facility- (nursing home size, ownership factors, staffing levels) level variables.
  
  
  RESULTS
  Of 8,262 subjects (in 4,131 pairs), 4.3% suffered any fracture during observation, with 1% having a hip fracture during an average follow-up period of 93 ± 71 days (range 1-293 days). Antipsychotic initiation was associated with any fracture (hazard ratio (HR) = 1.39, P = .004) and hip fracture (HR = 1.76, P = .02). The highest risk was found for hip fracture when antipsychotic use was adjusted for dose (HR = 2.96, P = .008), but no differences in time to fracture were found between first- and second-generation agents or between individual drugs.
  
  
  CONCLUSIONS
  Antipsychotic initiation is associated with fracture in nursing home residents, but risk does not differ between commonly used antipsychotics.
authors.affiliation: Department of Medicine and, School of Medicine, University of Kansas, Kansas City, Kansas 66160, USA. srigler@kumc.edu
authors.forename: Sally K
authors.initials: SK
authors.lastname: Rigler
authors.forename: Theresa I
authors.initials: TI
authors.lastname: Shireman
authors.forename: Galen J
authors.initials: GJ
authors.lastname: Cook-Wiens
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Whittle
authors.forename: David R
authors.initials: DR
authors.lastname: Mehr
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Mahnken
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D057216:Propensity Score; D011618:Psychotic Disorders / Q000188:drug therapy*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents