Falls and Fractures With Atypical Antipsychotic Medication Use

Abstract

pared with never users. Cumulative use was not associated with increased odds of acute pancreatitis (P for trend among users = .49). Use of other antiarrhythmic drugs was not associated with acute pancreatitis (Table 2). Discussion | In this study of health care utilization data, use of amiodarone but not of other antiarrhythmic drugs was associated with a 50% increased odds of acute pancreatitis among patients with NVAF. The odds were almost doubled in the 12 months after amiodarone therapy initiation and did not depend on cumulative use of amiodarone. Considering an incidence of acute pancreatitis of 3 to 4 cases per 10 000 adults per year, 4 the observed association would result in approximately 1 to 2 additional cases of acute pancreatitis per 10 000 amiodarone users per year. A few isolated case reports of acute pancreatitis possibly linked to amiodarone use have been described in the literature. 1-3 The mechanisms responsible for this association are unknown, although direct cytotoxicity or immune-mediated pathways, as described for amiodarone-related pulmonary toxic effects, could be potential explanations. 5 Strengths of our study include the prospective assessment of medication use, the large sample size, and the availability of information on comorbidities and use of other medications potentially associated with increased risk of acute pancreatitis. Limitations are related to the use of health care utilization data: limited information on the validity of claims for acute pancreatitis, absence of clinical variables that characterize severity of the episode (eg, blood markers of acute pancreatitis), and the select group of patients included in this database. Our results indicate that acute pancreatitis could be an adverse effect of amiodarone use, an effect that may not be shared by other antiarrhythmic drugs. Even though the absolute risk of acute pancreatitis in the general population is low, health care professionals should be aware of this potential association in the treatment of patients with NVAF or acute pancreatitis. Further research should replicate our findings and determine potential mechanisms.

Stability of Geriatric Syndromes in Hospitalized Medicare Beneficiaries Discharged to Skilled Nursing Facilities

“…Thus, change in the total number of prescribed medications was monitored from hospital to SNF discharge as part of this study. Polypharmacy was defined as five or more medications and hyperpolypharmacy as 10 or more medications …”

A novel role for dopamine signaling in the pathogenesis of bone loss from the atypical antipsychotic drug risperidone in female mice

“…Fracture risk is elevated in schizophrenic patients who take AAs compared to the general population and AA-induced bone changes may account for a portion of this increased risk [7]. Also, limited studies show that patients treated with risperidone (RIS, one of the first approved AA drugs which continues to be widely used) and other AA drugs have reduced bone mineral density (BMD) and increased fracture risk [8–16]. These data are especially concerning in populations such as the elderly and anorexia nervosa patients where fracture risk is already elevated.…”

Lower Bone Mineral Density at the Hip and Lumbar Spine in People with Psychosis Versus Controls: a Comprehensive Review and Skeletal Site-Specific Meta-analysis

“…This increased prevalence of osteoporosis and osteopenia in patients with schizophrenia is of particular concern because of their increased risk of falls [12] and fractures, which can have a serious negative impact on the patient’s mental state [4••]. Patients with schizophrenia have a longer recovery time after hip fracture, spending on average 11 days more in hospital compared with those with no mental health conditions [13••] and are at a greater risk of adverse events such as postoperative infection, deterioration of mental state and renal failure [13••].…”