title: Danish register-based study on the association between specific antipsychotic drugs and fractures in elderly individuals.
abstract: antipsychotic drugs (APs) have been associated with falls and fractures in elderly individuals but limited knowledge on specific drugs exist.
  
  
  
  to investigate the association between individual APs and fractures in elderly persons.
  
  
  
  nationwide register-based cohort study.
  
  
  
  all Danish individuals aged ≥65 who had not been in treatment with any AP in the year before inclusion.
  
  
  
  incidence rate ratios (IRRs) of fractures of hip, pelvis or upper extremities during treatment with commonly used APs were assessed in multivariable Poisson models. Exposure was divided into time periods from initiation of treatment: 0-30 days, 31-365 days or >365 days.
  
  
  
  one year prior to inclusion, 1,540,915 individuals ≥65 years had not received APs and of these 93,298 initiated treatment with APs. Mean follow-up was 9.6 years. During follow-up, 246,057 (16%) experienced a fracture. Associations were for all APs highest in the initial treatment period (0-30 days) with IRRs for risperidone 1.97 (95% CI: 1.70-2.28), olanzapine 2.31 (95% CI: 1.96-2.73), quetiapine 2.09 (95% CI: 1.73-2.52), zuclopenthixol 2.19 (95% CI: 1.82-2.63), chlorprothixen 1.62 (95% CI: 1.18-2.24), flupenthixol 1.43 (95% CI: 1.06-1.93), levomepromazine 1.19 (95% CI 0.86-1.66), haloperidol 2.98 (95% CI 2.57-3.45), compared with the background population.
  
  
  
  use of APs is associated with fractures in elderly persons especially in the initial treatment period. If AP use in an elderly person is deemed necessary, individual falls prophylaxis should be considered.
authors.affiliation: Department of Internal Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
authors.forename: Maia
authors.initials: M
authors.lastname: Torstensson
authors.affiliation: Department of Internal Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
authors.forename: Katja
authors.initials: K
authors.lastname: Leth-Møller
authors.affiliation: Department of Cardiology, University Hospital Gentofte, Gentofte, Denmark.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Andersson
authors.affiliation: Department of Health, Science and Technology, Aalborg University and Department of Cardiology and Clinical Epidemiology Aalborg University Hospital, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Department of Cardiology, University Hospital Gentofte, Gentofte, Denmark.|Department of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Gunnar Hilmar
authors.initials: GH
authors.lastname: Gislason
authors.affiliation: Department of Internal Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
authors.forename: Ellen Astrid
authors.initials: EA
authors.lastname: Holm
mesh_terms: D000058:Accidental Falls; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D012042:Registries; D012307:Risk Factors; D013997:Time Factors
chemical_list: D014150:Antipsychotic Agents
keywords: antipsychotics; falls; fractures; older people; pharmacoepidemiology