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

S. H. Lee, W. T. Hsu, C. C. Lai, A. Esmaily-Fard, Y. W. Tsai, C. C. Chiu, J. Wang, S. S. Chang, C. C. Lee

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Summary: Our systematic review and meta-analysis of observational studies indicated that the use of antipsychotics was associated with a nearly 1.5-fold increase in the risk of fracture. First-generation antipsychotics (FGAs) appeared to carry a higher risk of fracture than second-generation antipsychotics (SGAs). Introduction: The risk of fractures associated with the use of antipsychotic medications has inconsistent evidence between different drug classes. A systematic review and meta-analysis was conducted to evaluate whether there is an association between the use of antipsychotic drugs and fractures. Methods: Searches were conducted through the PubMed and EMBASE databases to identify observational studies that had reported a quantitative estimate of the association between use of antipsychotics and fractures. The summary risk was derived from random effects meta-analysis. Results: The search yielded 19 observational studies (n = 544,811 participants) with 80,835 fracture cases. Compared with nonuse, use of FGAs was associated with a significantly higher risk for hip fractures (OR 1.67, 95% CI, 1.45–1.93), and use of second generation antipsychotics (SGAs) was associated with an attenuated but still significant risk for hip fractures (OR 1.33, 95% CI, 1.11–1.58). The risk of fractures associated with individual classes of antipsychotic users was heterogeneous, and odds ratios ranged from 1.24 to 2.01. Chlorpromazine was associated with the highest risk (OR 2.01, 95% CI 1.43–2.83), while Risperidone was associated with the lowest risk of fracture (OR 1.24, 95% CI 0.95–1.83). Conclusions: 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.

Original languageEnglish
Pages (from-to)1167-1178
Number of pages12
JournalOsteoporosis International
Volume28
Issue number4
DOIs
Publication statusPublished - Apr 1 2017
Externally publishedYes

Fingerprint

Antipsychotic Agents
Meta-Analysis
Hip Fractures
Observational Studies
Off-Label Use
Risperidone
Chlorpromazine
PubMed
Odds Ratio
Databases

Keywords

  • Antipsychotics
  • Atypical antipsychotics
  • Conventional antipsychotics
  • Femur fracture
  • First-generation antipsychotics
  • Fracture
  • Hip fracture
  • Second-generation antipsychotics

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Lee, S. H., Hsu, W. T., Lai, C. C., Esmaily-Fard, A., Tsai, Y. W., Chiu, C. C., ... Lee, C. C. (2017). Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis. Osteoporosis International, 28(4), 1167-1178. https://doi.org/10.1007/s00198-016-3881-3

Use of antipsychotics increases the risk of fracture : a systematic review and meta-analysis. / Lee, S. H.; Hsu, W. T.; Lai, C. C.; Esmaily-Fard, A.; Tsai, Y. W.; Chiu, C. C.; Wang, J.; Chang, S. S.; Lee, C. C.

In: Osteoporosis International, Vol. 28, No. 4, 01.04.2017, p. 1167-1178.

Research output: Contribution to journalArticle

Lee, SH, Hsu, WT, Lai, CC, Esmaily-Fard, A, Tsai, YW, Chiu, CC, Wang, J, Chang, SS & Lee, CC 2017, 'Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis', Osteoporosis International, vol. 28, no. 4, pp. 1167-1178. https://doi.org/10.1007/s00198-016-3881-3
Lee, S. H. ; Hsu, W. T. ; Lai, C. C. ; Esmaily-Fard, A. ; Tsai, Y. W. ; Chiu, C. C. ; Wang, J. ; Chang, S. S. ; Lee, C. C. / Use of antipsychotics increases the risk of fracture : a systematic review and meta-analysis. In: Osteoporosis International. 2017 ; Vol. 28, No. 4. pp. 1167-1178.
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AU - Lai, C. C.

AU - Esmaily-Fard, A.

AU - Tsai, Y. W.

AU - Chiu, C. C.

AU - Wang, J.

AU - Chang, S. S.

AU - Lee, C. C.

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N2 - Summary: Our systematic review and meta-analysis of observational studies indicated that the use of antipsychotics was associated with a nearly 1.5-fold increase in the risk of fracture. First-generation antipsychotics (FGAs) appeared to carry a higher risk of fracture than second-generation antipsychotics (SGAs). Introduction: The risk of fractures associated with the use of antipsychotic medications has inconsistent evidence between different drug classes. A systematic review and meta-analysis was conducted to evaluate whether there is an association between the use of antipsychotic drugs and fractures. Methods: Searches were conducted through the PubMed and EMBASE databases to identify observational studies that had reported a quantitative estimate of the association between use of antipsychotics and fractures. The summary risk was derived from random effects meta-analysis. Results: The search yielded 19 observational studies (n = 544,811 participants) with 80,835 fracture cases. Compared with nonuse, use of FGAs was associated with a significantly higher risk for hip fractures (OR 1.67, 95% CI, 1.45–1.93), and use of second generation antipsychotics (SGAs) was associated with an attenuated but still significant risk for hip fractures (OR 1.33, 95% CI, 1.11–1.58). The risk of fractures associated with individual classes of antipsychotic users was heterogeneous, and odds ratios ranged from 1.24 to 2.01. Chlorpromazine was associated with the highest risk (OR 2.01, 95% CI 1.43–2.83), while Risperidone was associated with the lowest risk of fracture (OR 1.24, 95% CI 0.95–1.83). Conclusions: 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.

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KW - Hip fracture

KW - Second-generation antipsychotics

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