Abstract:To date, the actual relationship between antimuscarinics for overactive bladder (OAB) syndrome and the subsequent risk of a fracture remains unclear. The aim of this retrospective cohort study was to demonstrate the association between antimuscarinics for OAB and fractures using a large population-based data set. Data used in this study were taken from the Taiwan Longitudinal Health Insurance Database 2005. We identified 2927 OAB patients who received antimuscarinics as the study cohort and 11 708 matched OAB … Show more
“…One study by Gomes et al reported that the risk of serious falls among individuals with OAB treated with two different antimuscarinics was similar (0.8% for tolterodine vs. 0.7% for oxybutynin) [ 20 ]. In the other study, the unadjusted PAR for any fracture was slightly higher among individuals with OAB who had been prescribed an antimuscarinic (3.01) compared to those who had not been prescribed an antimuscarinic (2.77) [ 28 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…4 ) [ 8 , 22 , 27 ]. No difference in risk of fractures was observed in either study that examined the impact of treatment [ 20 , 28 ].…”
IntroductionUrinary symptoms are associated with an increased risk of falls, but few studies have focused on patients with overactive bladder (OAB). This study aimed to synthesize estimates of the risk of falls and fractures in patients with OAB.MethodsMedline, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were systematically searched for observational studies that focused on patients with OAB. When available, data from a non-OAB comparison sample were included. Double independent review and data extraction were performed. Falls and fractures data were summarized by unadjusted and adjusted risks, and percent attributable risk (PAR) of falls and fractures associated with OAB.ResultsFifteen studies were included in the analyses. The proportion of patients with OAB experiencing at least one fall over a year ranged from 18.9% to 50.0%, and the proportion of patients with OAB experiencing recurrent or serious falls ranged from 10.2% to 56.0%. In studies that included a non-OAB comparison sample, a higher risk of falls was observed in patients with OAB compared to those without. A significantly increased (1.3- to 2.3-fold) adjusted OAB-associated risk of falls was reported, while unadjusted PARs for OAB associated falls ranged from 3.7% to 15.5%. Risk was higher among women and those 65 years of age or older. While analysis of fractures showed elevated point estimates, most studies were underpowered to detect a statistically significant difference between groups.ConclusionsEvidence from the published literature clearly demonstrates the importance of OAB and its symptoms as risk factors for falls and fractures.FundingAstellas.Electronic supplementary materialThe online version of this article (10.1007/s12325-018-0796-8) contains supplementary material, which is available to authorized users.
“…One study by Gomes et al reported that the risk of serious falls among individuals with OAB treated with two different antimuscarinics was similar (0.8% for tolterodine vs. 0.7% for oxybutynin) [ 20 ]. In the other study, the unadjusted PAR for any fracture was slightly higher among individuals with OAB who had been prescribed an antimuscarinic (3.01) compared to those who had not been prescribed an antimuscarinic (2.77) [ 28 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…4 ) [ 8 , 22 , 27 ]. No difference in risk of fractures was observed in either study that examined the impact of treatment [ 20 , 28 ].…”
IntroductionUrinary symptoms are associated with an increased risk of falls, but few studies have focused on patients with overactive bladder (OAB). This study aimed to synthesize estimates of the risk of falls and fractures in patients with OAB.MethodsMedline, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were systematically searched for observational studies that focused on patients with OAB. When available, data from a non-OAB comparison sample were included. Double independent review and data extraction were performed. Falls and fractures data were summarized by unadjusted and adjusted risks, and percent attributable risk (PAR) of falls and fractures associated with OAB.ResultsFifteen studies were included in the analyses. The proportion of patients with OAB experiencing at least one fall over a year ranged from 18.9% to 50.0%, and the proportion of patients with OAB experiencing recurrent or serious falls ranged from 10.2% to 56.0%. In studies that included a non-OAB comparison sample, a higher risk of falls was observed in patients with OAB compared to those without. A significantly increased (1.3- to 2.3-fold) adjusted OAB-associated risk of falls was reported, while unadjusted PARs for OAB associated falls ranged from 3.7% to 15.5%. Risk was higher among women and those 65 years of age or older. While analysis of fractures showed elevated point estimates, most studies were underpowered to detect a statistically significant difference between groups.ConclusionsEvidence from the published literature clearly demonstrates the importance of OAB and its symptoms as risk factors for falls and fractures.FundingAstellas.Electronic supplementary materialThe online version of this article (10.1007/s12325-018-0796-8) contains supplementary material, which is available to authorized users.
“…Numerous patients with bladder diseases may exhibit a complex of symptoms known as overactive bladder (OAB), characterized by urgency, frequency and nocturia, with or without urinary incontinence ( 4 ). It was reported that metastatic breast cancer was also associated with OAB-like symptoms ( 4 , 5 ). Whether these symptoms are associated with molecular features or with prognosis of bladder cancer remains unclear.…”
Section: Introductionmentioning
confidence: 99%
“…Antagonists of muscarinic acetylcholine receptors (mAChRs) remain the first-line therapy for treating OAB symptoms, such as urgency ( 6 ). Understanding the role of mAChRs in OAB requires the examination of all five receptor subtypes (M1R-M5R), all of which being located in the urothelium ( 4 ). The urothelium could respond to muscarinic agonist stimulation by self-releasing acetylcholine (ACh), which may modulate afferent activity in turn ( 7 ).…”
The objective of the present study was to explore the association between muscarinic cholinergic signaling and urothelial bladder tumors. Possible associations among overactive bladder (OAB) symptoms and bladder tumors were retrospectively investigated using a multicenter Chinese database with prospectively collected data since 2010. Firstly, it was demonstrated that OAB symptoms, such as urgency, were more severe in patients with invasive bladder cancer and were associated with a reduced prognosis. Following this, muscarinic cholinergic receptor 3 (M3R) expression in urothelium was determined to be lower in invasive cancer tissue than in adjacent non-cancerous tissue, yet M3R upregulation was associated with a reduced progression free survival (PFS) time. Additionally, it was also demonstrated that muscarinic cholinergic receptor 2 (M2R) was upregulated in the sub-urothelium, and this was also associated with a reduced PFS time. Furthermore, it was determined that cholinesterase and acetylcholinesterase were lower in invasive cancer than in non-invasive cancer. In conclusion, the results indicated that M3R expression was downregulated in invasive bladder cancer, which may have a role as a protective anti-oncogene, in contrast to its oncogenic role in numerous other cancer types. Therefore, muscarinic cholinergic signaling may be a novel therapeutic target for treating bladder cancer.
“…[ 32 – 34 ] The study used the Longitudinal Health Insurance Database (LHID) obtained from the NHI Research Database (NHIRD), consisting of 1 million beneficiaries randomly sampled from the original NHI beneficiaries. [ 35 , 36 ] The National Health Research Institute in Taiwan permitted the access to the data in the NHIRD and the database includes the entire registry and claims data from this this health insurance system. [ 32 – 37 ] The accuracy of diagnosis in the NIRD has been validated for several diseases, including stroke and CKD.…”
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