Association between Anti-Psychotic Drugs Use and Hip Fractures in Patients with Dementia: A Nationwide Population-Based Study

Tang, Chia-Hung; Lai, Yi-Chen; Chen, Yi-Chen; Chang, Shun-Min; Chen, Yu-Han; Liao, Jung-Yu; Wang, Yi-Chi; Ho, Chung-Han; Chen, Ping-Jen

doi:10.3390/ijerph18158118

Open AccessArticle

Association between Anti-Psychotic Drugs Use and Hip Fractures in Patients with Dementia: A Nationwide Population-Based Study

by

Chia-Hung Tang

^1,†,

Yi-Chen Lai

^2,†,

Yi-Chen Chen

³,

Shun-Min Chang

⁴,

Yu-Han Chen

⁵,

Jung-Yu Liao

⁶

,

Yi-Chi Wang

⁷,

Chung-Han Ho

^3,8,*,‡

and

Ping-Jen Chen

^{9,10,11,*,‡}

¹

Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan 700, Taiwan

²

Department of Emergency Medicine, An Nan Hospital, China Medical University, Tainan 709, Taiwan

³

Department of Medical Research, Chi Mei Medical Center, Tainan 710, Taiwan

⁴

Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan

⁵

Department of Family Medicine, Chi-Mei Medical Center, Tainan 710, Taiwan

⁶

Department of Public Health, Kaohsiung Medical University, Kaohsiung 807, Taiwan

⁷

Department of Family Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan

⁸

Department of Information Management, Southern Taiwan University of Science and Technology, Tainan 710, Taiwan

⁹

Division of Psychiatry, University College London, London W1T 7NF, UK

¹⁰

Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan

¹¹

School of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan

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^*

Authors to whom correspondence should be addressed.

^†

These authors contributed equally.

^‡

These authors also contributed equally.

Int. J. Environ. Res. Public Health 2021, 18(15), 8118; https://doi.org/10.3390/ijerph18158118

Submission received: 23 June 2021 / Revised: 23 July 2021 / Accepted: 27 July 2021 / Published: 31 July 2021

(This article belongs to the Special Issue Dementia Research: Epidemiology and Public Health)

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Abstract

Background: People with dementia are a high-risk group for hip fractures. Although the increased risk of hip fractures associated with antipsychotic drugs (APD) is found in older populations, little is known about the risk for people with dementia living in Asia. We aimed to investigate the association between hip fractures and the characteristics of APD use in patients with dementia. Methods: A nested case-control analysis was conducted on a nationwide cohort in Taiwan. People with diagnoses of dementia during 2003–2012 were identified. Conditional logistic regression analysis was performed, and adjusted odds ratios (aORs) were calculated with a 95% confidence interval (CI) to estimate the risk of hip fractures. Results: APD use was associated with an increased risk of hip fractures in patients with dementia; current use or combined use of first and second generations of APDs had even higher risks. Regarding the duration of APD use, a U-shape curve of hip fracture risk was noted, and the risk peaked during 0–15 days and >215 days of exposure (aOR = 1.46, 95% CI 1.37–1.57; aOR = 1.47, 95% CI 1.37–1.58; respectively). Considering the doses of APDs, the hip fracture risk was significantly increased with all four levels of the cumulative doses and average daily doses and peaked in the group with the highest average daily dose. Conclusions: The findings suggest that caution must be taken when initiating APD use in patients with dementia, even in a small dose, and mixed types of APD prescriptions should be administered with care. Furthermore, frequent evaluation of the possibility of tapering or withdrawal of the medication is necessary, as the risk does not attenuate after long-term use.

Keywords: antipsychotic drugs; dementia; hip fracture; epidemiology; national health program

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MDPI and ACS Style

Tang, C.-H.; Lai, Y.-C.; Chen, Y.-C.; Chang, S.-M.; Chen, Y.-H.; Liao, J.-Y.; Wang, Y.-C.; Ho, C.-H.; Chen, P.-J. Association between Anti-Psychotic Drugs Use and Hip Fractures in Patients with Dementia: A Nationwide Population-Based Study. Int. J. Environ. Res. Public Health 2021, 18, 8118. https://doi.org/10.3390/ijerph18158118

AMA Style

Tang C-H, Lai Y-C, Chen Y-C, Chang S-M, Chen Y-H, Liao J-Y, Wang Y-C, Ho C-H, Chen P-J. Association between Anti-Psychotic Drugs Use and Hip Fractures in Patients with Dementia: A Nationwide Population-Based Study. International Journal of Environmental Research and Public Health. 2021; 18(15):8118. https://doi.org/10.3390/ijerph18158118

Chicago/Turabian Style

Tang, Chia-Hung, Yi-Chen Lai, Yi-Chen Chen, Shun-Min Chang, Yu-Han Chen, Jung-Yu Liao, Yi-Chi Wang, Chung-Han Ho, and Ping-Jen Chen. 2021. "Association between Anti-Psychotic Drugs Use and Hip Fractures in Patients with Dementia: A Nationwide Population-Based Study" International Journal of Environmental Research and Public Health 18, no. 15: 8118. https://doi.org/10.3390/ijerph18158118

APA Style

Tang, C.-H., Lai, Y.-C., Chen, Y.-C., Chang, S.-M., Chen, Y.-H., Liao, J.-Y., Wang, Y.-C., Ho, C.-H., & Chen, P.-J. (2021). Association between Anti-Psychotic Drugs Use and Hip Fractures in Patients with Dementia: A Nationwide Population-Based Study. International Journal of Environmental Research and Public Health, 18(15), 8118. https://doi.org/10.3390/ijerph18158118

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Association between Anti-Psychotic Drugs Use and Hip Fractures in Patients with Dementia: A Nationwide Population-Based Study

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