Original Article

Drugs with Anticholinergic Properties and Association with Hip Fractures in Older Patients: A Danish Nationwide Cohort-Study

Rebekka Vedelsbøl^1,2, Pavithra Laxsen Anru³, Jesper Ryg^1,2

1. Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
2. Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
3. Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark

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Keywords: Anticholinergic drugs, Cohort study, Falls, Geriatric, Hip fractures

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Abstract

Objectives: Hip fractures (HFx) resulting from falls are a significant health concern, and drugs with anticholinergic properties (DAP) increase the risk of falls. This study aimed to assess the association between use of DAP at hospital admission and HFx risk in older patients. Methods: This nationwide population-based study included all patients ≥65 years admitted to Danish geriatric wards during 2005-2014. Outcome of interest was first HFx within 2-years follow-up. The Anticholinergic Cognitive Burden (ACB) scale quantified DAP use. Cox regression analysis of data from four national registries was adjusted for activities of daily living, age, marital status, admission year, BMI, fracture history, previous admissions, dementia, anti-osteoporotic drugs, and Charlson comorbidity index. Results: 74,589 patients (62.8% female) were included, 45,463 (60.9%) received DAP at index, and 7,861 HFx occurred during follow-up. Cumulative 2-year HFx hazard was highest for ACB=0 (15.3%). Higher ACB-score was not associated with increased HFx risk in univariable nor multivariable analyses. In sensitivity analysis, use of DAP with high anticholinergic burden (≥2) did not alter results. Conclusions: In this high-incidence national cohort, higher ACB-score was not associated with increased HFx risk. Our results call for further research on association between specific DAP and risk of HFx.

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