Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis

Abstract

FGA users were at a higher risk of hip fracture than SGA users. Both FGAs and SGAs were associated with an increased risk of fractures, especially among the older population. Therefore, the benefit of the off-label use of antipsychotics in elderly patients should be weighed against any risks for fracture.

Central Nervous System Agent Classes and Fragility Fracture Risk among Elderly Japanese Individuals in a Nationwide Case-Crossover Design Study

“…A meta-analysis by Shen et al in 2014 estimated the fracture risk of antiepileptic agents 8) and showed a relative risk (RR) of 2.0 for cohort studies and 1.8 for case-control studies. Another meta-analysis by Takkouche et al in 2007 3) showed a RR of 1.5 for non-barbiturates and 2.2 for barbiturates.…”

“…Shiek et al reported that fractures occurred more often during treatment with antiepileptic agents in patients without vs. with seizures. 23) Involvement of low bone mineral density from antiepileptic agent-mediated hepatic enzyme induction 8,24) and drowsiness related to use of antiepileptic agents 8) are reported as the underlying mechanisms. In the present study, the existence of seizure prior to the occurrence of fragility fractures was unclear, but percentage of elderly individuals who used .…”

“…6,7) Thus far, the association between the use of CNS agents and fracture risk has been investigated by focusing on each medication individually or by analyzing the risk with the use of some restricted classes of CNS agents, such as antiepileptic agents, antidepressants, antipsychotics, benzodiazepines, and opioids. [3][4][5][8][9][10][11][12][13][14][15] However, no study has estimated the fracture risk of a wide range of CNS agent classes to the best of our knowledge. A study among individuals in the same population using the same definitions of exposure and outcome makes fracture risk among CNS agent classes appropriate to compare and easy to interpret.…”

Association rules method and big data: Evaluating frequent medication combinations associated with fractures in older adults

“…9 However, there is a conflicting information about the role of medications and medication combinations as risk factors for fractures. [10][11][12] Fractures are associated with physical and mental disability, increased mortality, and increased hospital costs. [13][14][15] There is a strong evidence that exposure to polypharmacy (concurrent use of 5 or more medications) and certain medication classes particularly psychotropic medications are associated with an increased risk of fractures in older adults.…”

Antipsychotics and Low Vitamin D – Additional Data Calling for Drug Causality Assessment

“…Antipsychotics could affect calcium, magnesium, phosphorous and 25(OH)D serum concentrations during treatment initiations as well as during dosage or drug changes (4). Disturbances in minerals and vitamins related to bone metabolism can lead to increased risks for fractures associated with the use of the first and the second generation of antipsychotic medication as was documented in a recent meta-analysis of the available data (5). However, the evidence base for a definite assessment of the possible causality relations between vitamin D disturbances and antipsychotic drugs remains insufficient.…”