title: Anticholinergic Medication Use and Fractures in Postmenopausal Women: Findings from the Women's Health Initiative.
abstract: BACKGROUND
  Anticholinergic medication use has been associated with several negative health outcomes in older adults, but little is known about its risk for fractures.
  
  
  OBJECTIVE
  To examine the association between anticholinergic medication use and fracture outcomes in community-dwelling postmenopausal women.
  
  
  METHODS
  Utilizing a prospective cohort design, we examined data collected from 137,408 women aged 50-79 years from the Women's Health Initiative observational study and clinical trials not reporting hip fracture at baseline. Medications with moderate or strong anticholinergic effects were identified directly from drug containers during in-person interviews. The main outcome was fractures (hip, lower arm/wrist and total fractures). We performed multivariable Cox proportional hazard survival modelling to assess the association between anticholinergic use and the risk of fractures.
  
  
  RESULTS
  At baseline, 10.6% of the women were using an anticholinergic medication, of which antihistamines were the most common medication class (48.4%). The multivariable-adjusted hazard ratios for anticholinergic medication use were 1.08 (95% confidence interval [CI] 0.89-1.30) for hip fracture, 1.01 (95% CI 0.91-1.13) for lower arm/wrist fracture and 1.03 (95% CI 0.98-1.09) for total fractures. We observed no association according to subclass or count of anticholinergic medications, or trends between the duration of anticholinergic use and any of the fracture outcomes.
  
  
  CONCLUSIONS
  Anticholinergic medication use was not associated with an increased risk of fractures among community-dwelling women. Future research should make efforts to capture over-the-counter medication use and the cumulative anticholinergic burden in relation to important health outcomes for older adults.
authors.affiliation: School of Pharmacy, University of Washington, 1959 NE Pacific Street, H375G, Box 357630, Seattle, WA, 98195-7630, USA. zmarcum@uw.edu.
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Marcum
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Heidi S
authors.initials: HS
authors.lastname: Wirtz
authors.affiliation: WHI Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Pettinger
authors.affiliation: WHI Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Carnahan
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.affiliation: University of Arizona Cancer Center, Tucson, AZ, USA.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Bea
authors.affiliation: School of Pharmacy, University of Washington, 1959 NE Pacific Street, H375G, Box 357630, Seattle, WA, 98195-7630, USA.
authors.forename: Shelly L
authors.initials: SL
authors.lastname: Gray
mesh_terms: D000368:Aged; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk
chemical_list: D018680:Cholinergic Antagonists