Table 3 Studies on the risk of hip/femur fracture associated with antipsychotic medicines
Study | Population | Outcome | Propensity for bias/Study quality | Procedures to minimize bias | Follow-up | Outcome Rate in reference group | Result |
|---|---|---|---|---|---|---|---|
LEVEL III Evidence: Observational Studies | |||||||
Studies that compared atypical antipsychotic (ATYP) treatment to non-use (NU) | |||||||
COHORT STUDIES | |||||||
Normand [46] | 1286395 All patients (Canada) (age>65) | Hip fracture | Moderate/Low | Yes (covariate adjustment) | NR | NR | OR (ATYP v NU); 2.2 95% CI; 2.1-2.4 |
CASE-CONTROL STUDIES | |||||||
Liperoti [47] | 1787 cases, 5606 controls Institutionalised patients (US) (age>=65) | Hospitalisation for hip fracture ICD9 820-821 | Moderate/Moderate | Yes (matched on; admitted to same facility for septicemia, GI, MI) | NR | NA | OR (ATYP v NU); 1.37 95% CI; 1.11-1.69 OR (RISP v NU); 1.42 95% CI; 1.12-1.80 OR (OLA v NU); 1.34 95% CI; 0.87-2.07 OR (OTHERATYP v NU); 1.03 95% CI; 0.47-2.28 |
Kolanowski [35] | 959 Dementia patients, health care insured on Southeast US (age>70) | Diagnosis of hip Fracture | Moderate/Low | Yes (unmatched covariate adjustment) | 45 days | NA | OR (ATYP v NU); 1.47 95% CI; 0.82-2.65 |
Pouwels [48] | 6763 cases, 26341 controls All patients, PHARMO Database (Netherlands) (age>18) | Hospitalis-ation for Hip fracture | Moderate/Low | Yes (Matched on; year of birth, sex, geographic region) | 12 years | NA | OR (ATYP v NU); 0.83 95% CI; 0.42-1.65 |
Jalbert [49] | 764 cases, 3582 controls Long stay Medicaid-eligible resident living in nursing homes with at least 20 beds (age>65) | Hospitalis-ation for Hip fracture ICD9 820 | Moderate/Low | Yes (Matched; admitted to same facility, covariate adjustment) | 2 years | NA | New use: OR (ATYP v NU); 1.36 95% CI; 0.95-1.94 Prevalent use: OR (ATYP v NU); 1.33 95% CI; 1.08-1.63 |
SELF-CONTROLLED CASE SERIES STUDIES | |||||||
Pratt [50] | 8285, Australian Department of Veterans Affairs Veterans/spouses with hospitalization for hip fracture (Australia) (age>=65) | Hospitalis-ation for Hip fracture ICD10 S720, S721 | Moderate/Moderate | Yes (within patient design) | 4 years | NA | 1 week: IRR (ATYP V UEXP); 2.17 95% CI; 1.54-3.06 2-8 weeks: IRR (ATYP V UEXP); 1.27 95% CI; 1.04-1.55 9-12 weeks: IRR (ATYP V UEXP); 1.23 95% CI; 0.92-1.63 >12 weeks: IRR (ATYP V UEXP); 1.43 95% CI; 1.23-1.66 |
Studies that compared conventional antipsychotic (CONV) treatment to non-use (NU) | |||||||
CASE-CONTROL STUDIES | |||||||
Liperoti [47] | 1787 cases, 5606 controls Institutionalised patients (US) (age>=65) | Hospitalis-ation for hip fracture | Moderate | Yes (covariate adjustment and matched; on admitted to same facility for septicemia,GI,MI) | NR | NA | OR (CONV v NU); 1.35 95% CI; 1.06-1.71 OR (HALO v NU); 1.53 95% CI; 1.18-2.26 OR (OTHERCONV v NU); 1.09 95% CI; 0.78-1.52 |
Kolanowski [35] | 959 Dementia patients, health care insured on Southeast US (age>70) | Diagnosis of hip Fracture | Moderate | Yes (covariate adjustment) | 45 days | NA | OR (CONV v NU); 2.33 95% CI; 1.08-5.03 |
Pouwels [48] | 6763 cases, 26341 controls All patients, PHARMO Database (Netherlands) (age>18) | Hospitalis-ation for Hip fracture | Moderate | Yes (Matched; year of birth, sex, geographic region) | 12 years | NA | OR (CONV v NU); 1.76 95% CI; 1.48-2.08 |
Jalbert [49] | 764 cases, 3582 controls Long stay Medicaid-eligible resident living in nursing homes with at least 20 beds (age>65) | Hospitalis-ation for Hip fracture | Moderate | Yes (Matched; admitted to same facility) | 2 years | NA | Prevalent use: OR (CONV v NU); 1.28 95% CI; 0.7-2.34 |
SELF-CONTROLLED CASE SERIES STUDIES | |||||||
Pratt et al. [50] | 8285, Australian Department of Veterans Affairs Veterans/spouses with hospitalization for hip fracture (Australia) (age>=65) | Hospitalis-ation for Hip fracture ICD10 S720, S721 | Moderate | Yes (within patient design) | 4 years | NA | 1 week: IRR (CONV V UEXP); 1.04 95% CI; 0.40-2.70 2-8 weeks: IRR (CONV V UEXP); 2.23 95% CI; 1.65-3.02 9-12 weeks: IRR (CONV V UEXP); 1.79 95% CI; 1.12-2.84 >12 weeks: IRR (CONV V UEXP); 2.19 95% CI; 1.62-2.95 |
Studies that compared all antipsychotics with non-use (NU) | |||||||
CASE-CONTROL STUDIES | |||||||
Wang [51] | 1222 cases, 4888 controls Elderly patients enrolled in Medicare as well as in the New Jersey Medicaid or Pharmaceutical Assistance to the Aged and Disabled programs (age>=65) | Hospitalis-ation for hip fracture | Moderate/Moderate | Yes (matched on; year birth and gender, covariate adjustment) | NR | NA | OR (ATYP v NU); 1.60 95% CI NR |
Studies that compared conventional antipsychotic (CONV) and atypical antipsychotic (ATYP) treatment | |||||||
COHORT STUDIES | |||||||
Normand [46] | 1286395 All patients, in Ontario (Canada) (age>65) | Hip fracture | Moderate/Low | Yes (covariate adjustment) | NR | NR | OR (ATYP v CONV); 0.5 95% CI; 0.4-0.5 |