Antipsychotic use and the risk of hip fracture among older adults afflicted with dementia

Objective: To quantify the association between use of antipsychotic (AP) medications and the risk of hip fracture among older adults residing in a nursing home (NH) and afflicted with dementia.

Design: Nested case-control study.

Setting: NHs in California, Florida, Illinois, New York, and Ohio in 2001-2002 (N=586).

Participants: The source population consisted of long-stay Medicaid-eligible residents living in NHs with at least 20 beds, who were 65 years of age or older and had a diagnosis of dementia but were not receiving hospice care, were not comatose, bedfast, paralyzed, or in a wheelchair, and had no record of a previous hip fracture (N=69,027). There were 764 cases of hip fracture identified; up to 5 controls, matched to cases on NH and quarter of Minimum Data Set (MDS) assessment, were randomly selected from the source population (N=3582).

Measurements: Cases of hip fracture were identified and medication use was ascertained from Medicaid claims data. Resident-level characteristics, including dementia severity, were obtained from resident MDS assessments.

Results: Current use of APs conveyed a small increased risk of hip fracture (adjusted odds ratio=1.26; 95% confidence interval: 1.05 -1.52). When analyzed separately, users of conventional antipsychotics had a slightly higher risk of hip fracture than residents on atypical agents. Long-term use of APs conferred a greater risk of hip fracture than short-term use.

Conclusion: APs appear to increase the risk of hip fracture among older adults with dementia residing in an NH. Hip fractures may be a contributory mechanism to the increased risk mortality observed among AP users.