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Atypical antipsychotic use and risk of fracture in persons with Parkinsonism

Authors

  • David D. Dore PharmD, PhD,

    Corresponding author
    1. i3 Drug Safety, Waltham, Massachusetts, USA
    2. Department of Community Health, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
    • i3 Drug Safety, 950 Winter Street, Suite 3800, Waltham, Massachusetts 02451
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  • Amal N. Trivedi MD, MPH,

    1. Department of Community Health, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
    2. Center for Gerontology and Health Care Research, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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  • Vincent Mor PhD,

    1. Department of Community Health, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
    2. Center for Gerontology and Health Care Research, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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  • Joseph H. Friedman MD,

    1. NeuroHealth, Warwick, Rhode Island and Department of Clinical Neurosciences, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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  • Kate L. Lapane PhD

    1. Department of Community Health, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
    2. Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia, USA
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  • Potential conflict of interest: Dr. Dore conducted this work while an employee of Brown University and, during this time, received consultancy fees from Pfizer Inc and i3 Drug Safety for work independent of this study. Dr. Lapane is the principal investigator on a grant to Brown University from Pfizer Inc., which she uses entirely to train doctoral students in pharmacoepidemiology. Dr. Friedman has received money for lectures, consulting or research from the following companies: Astra Zeneca, Novartis, Janssen, Acadia Phamaceuticals (experimental drug), Ovation Pharmaceuticals (experimental drug). Drs. Trivedi and Mor report no conflicts of interest.

Abstract

Our objective was to estimate the effect of atypical antipsychotics (AAs) on the rate of fractures in a parkinsonism population. We conducted an age- and state-matched nested case-control study in five states (CA, FL, NY, OH, IL) using the Medicaid analytic extract from 2001 to 2002. Eligible participants had a diagnosis of parkinsonism, excluding persons with secondary parkinsonism, bone cancer, bone infections, schizophrenia, schizoaffective disorder, and those who used conventional antipsychotics. The primary outcome was the occurrence of a fracture of the femur, ankle, fibula, tibia, humerus, radius, or ulna (N = 851). Risk-set sampling defined controls (N = 4220). We used conditional-logistic regression to derive adjusted odds ratios (AOR) and 95% confidence intervals of the association between fracture and use of quetiapine, risperidone, or olanzapine in the 60 days before the index date compared to nonuse. After adjustment for confounding, use of quetiapine (AOR 2.4; 95% CI 1.5–3.8), risperidone (AOR 1.2; 95% CI 0.9–1.7), or olanzapine (AOR 1.7; 95% CI 1.2–2.4) was associated with a higher rate of fracture. Use of an AA was associated with a higher rate of fracture in persons with parkinsonism. Prescribers must be cautious when using these agents in elderly persons with parkinsonism. © 2009 Movement Disorder Society

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