title: Effect of Anticholinergic Medications on Falls, Fracture Risk, and Bone Mineral Density Over a 10-Year Period.
abstract: BACKGROUND
  Many medications used in older adults have strong anticholinergic (ACH) properties, which may increase the risk of falls and fractures. Use of these medications was identified in a population-based Canadian cohort.
  
  
  OBJECTIVE
  To identify the fall and fracture risk associated with ACH medication use.
  
  
  METHODS
  Data collection and analysis were conducted at baseline, year 5, and year 10. Cross-sectional analyses were performed to examine associations between ACH medication use and falls. Time-dependent Cox regression was used to examine time to first nontraumatic fracture. Finally, change in bone mineral density (BMD) over 10 years was compared in ACH medication users versus nonusers.
  
  
  RESULTS
  Strongly ACH medications were used by 618 of 7753 participants (8.0%) at study baseline, 592 (9.5%) at year 5, and 334 (7.7%) at year 10. Unadjusted ACH medication use was associated with falls at baseline (odds ratio = 1.50; 95% CI = 1.14-1.98; P = 0.004), but the association was no longer significant after covariate adjustment. Similar results occurred at years 5 and 10. ACH medication use was associated with increased incident fracture risk before (hazard ratio = 1.22; CI = 1.13-1.32; P < 0.001) but not after covariate adjustment. Mean (SD) change in femoral neck BMD T-score over 10 years, in those using ACH medications at both years 0 and 5, was -0.60 (0.63) in ACH users versus -0.49 (0.45) in nonusers (P = 0.041), but this was not significant after covariate adjustment.
  
  
  CONCLUSIONS
  ACH medications were not found to be independently associated with an increased risk of falling, fractures, or BMD loss. Rather, factors associated with ACH medication use explained the apparent associations.
authors.affiliation: Western University, London, ON, Canada LisaAnn.Fraser@sjhc.london.on.ca.
authors.forename: Lisa-Ann
authors.initials: LA
authors.lastname: Fraser
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.affiliation: University of Manitoba, Winnipeg, MB, Canada.
authors.forename: William D
authors.initials: WD
authors.lastname: Leslie
authors.affiliation: McGill University, Montréal, QC, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Goltzman
authors.affiliation: University of Toronto, ON, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Josse
authors.affiliation: University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jerilynn
authors.initials: J
authors.lastname: Prior
authors.affiliation: Dalhousie University, Halifax, NS, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kaiser
authors.affiliation: University of Toronto, ON, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Kreiger
authors.affiliation: Memorial University of Newfoundland, St John's, NL, Canada.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Kovacs
authors.affiliation: Queen's University, Kingston, ON, Canada.
authors.forename: Tassos P
authors.initials: TP
authors.lastname: Anastassiades
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papaioannou
keywords: anticholinergic medications; bone mineral density; falls; fracture