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Wang F, Li H, Yi K, Wu Y, Bian Q, Guo B, Luo X, Kang Y, Wu Q, Ma Q. Long-term second-generation antipsychotics decreases bone formation and resorption in male patients with schizophrenia. Psychopharmacology (Berl) 2024; 241:1771-1780. [PMID: 38647696 DOI: 10.1007/s00213-024-06592-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
RATIONALE Patients with schizophrenia with second-generation antipsychotics (SGAs) treatment have shown an increased risk of bone fragility and susceptibility to fracture; however, it is still unclear whether this risk is derived from the effect of antipsychotics on balance of bone metabolism. OBJECTIVES We investigated the changes of two bone turnover biomarkers (BTMs) concentrations in people with schizophrenia receiving SGAs: procollagen type I aminoterminal propeptide (PINP) and C-terminal telopeptide of type I collagen (CTX-1) as BTMs of osteogenesis and bone resorption, respectively, to explore how antipsychotics contribute to bone fragility. METHODS We recruited 59 Chinese male patients with schizophrenia (32 drug-naïve first-episode (DNFE) patients and 27 chronic patients) to undergo 8 weeks SGAs treatment. Fasting peripheral blood samples of pre- and posttreatment were collected, plasma levels of PINP and CTX-1 were measured. RESULTS The interaction effects of group and time on PINP and CTX-1 concentrations were found (P = .016 and P = .008). There was a significant decrease for both BTMs concentrations of the posttreatment compared to the pretreatment (P<.001 and P = .003). Chronic patients had significantly higher changes of BTMs concentrations compared to DNFE patients (P = .048 and P = .024). There was a positive correlation of the two BTMs of pretreatment with disease course in DNFE group (r = .37, P = .039;r = .38, P = .035) and a negative correlation of PINP of pretreatment with age in the chronic group (r=-.40, P = .039). CONCLUSION Long-term SGAs medication inhibited osteogenesis in a dose- and time-dependent manner and damaged the balance of bone formation and bone resorption.
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Affiliation(s)
- Fan Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, 100096, China.
- Xinjiang Key Laboratory of Neurological Disorder Research, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, 830063, China.
- Medical Neurobiology Lab, Inner Mongolia Medical University, Huhhot, 010110, China.
| | - Hui Li
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing, 100871, China
| | - Kaijun Yi
- Department of Orthopedics, Xiangyang No. 1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang, 441000, Hubei, China
| | - Yan Wu
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, 100096, China
| | - Qingtao Bian
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, 100096, China
| | - Baoyan Guo
- Xinjiang Key Laboratory of Neurological Disorder Research, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, 830063, China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Yimin Kang
- Medical Neurobiology Lab, Inner Mongolia Medical University, Huhhot, 010110, China
| | - Qi Wu
- Fenyang College, Shanxi Medical University, Lvliang, 032200, China
- Department of Psychiatry, Changzhou Peace Hospital, The 102nd Hospital of The Chinese People's Liberation Army, Changzhou, 213003, China
| | - Qinghe Ma
- Department of Psychiatry, Changzhou Peace Hospital, The 102nd Hospital of The Chinese People's Liberation Army, Changzhou, 213003, China
- Department of Internal Medicine, The 904th Hospital of The Chinese People's Liberation Army, Wuxi, 214004, China
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Khalid J, Aparasu RR. Adverse effects associated with antipsychotic use in older adults. Expert Opin Drug Saf 2024:1-15. [PMID: 39076106 DOI: 10.1080/14740338.2024.2386377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/17/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION Antipsychotic (AP) medications are extensively utilized for diverse psychiatric and non-psychiatric conditions, but they are associated with significant adverse effects in older adults. This expert opinion review provides an updated profile of adverse effects associated with AP medications in older adults. AREAS COVERED This review specifically examines real-world evidence for adverse events associated with AP use, including all-cause mortality, falls and fractures, diabetes, cardiovascular and cerebrovascular events, acute kidney injury, venous thromboembolism/pulmonary embolism, extrapyramidal symptoms, and infections based on real-world evidence. EXPERT OPINION This comprehensive safety review of AP revealed multiple adverse events in older adults. All-cause mortality, more associated with typical APs than atypicals, underscores a dose-dependent risk, urging cautious prescribing practices and avoidance of typical APs. Falls/fractures associated with atypical APs highlight the importance of judicious dosing and -close monitoring, especially after initiation. Cardiovascular risks, particularly stroke, with AP use emphasize the need for vigilant monitoring. Extrapyramidal symptoms, more linked to typical APs, also pose a significant risk in older adults. Pneumonia and pulmonary embolism/venous thromboembolism demand cautious consideration of APs, prompting the need for additional real-world studies to inform clinical practice. Conflicting evidence on diabetes and acute kidney injury necessitates ongoing studies and further research in older adults.
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Affiliation(s)
- Javeria Khalid
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
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Mok PLH, Carr MJ, Guthrie B, Morales DR, Sheikh A, Elliott RA, Camacho EM, van Staa T, Avery AJ, Ashcroft DM. Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study. BMJ 2024; 385:e076268. [PMID: 38631737 PMCID: PMC11022137 DOI: 10.1136/bmj-2023-076268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To investigate risks of multiple adverse outcomes associated with use of antipsychotics in people with dementia. DESIGN Population based matched cohort study. SETTING Linked primary care, hospital and mortality data from Clinical Practice Research Datalink (CPRD), England. POPULATION Adults (≥50 years) with a diagnosis of dementia between 1 January 1998 and 31 May 2018 (n=173 910, 63.0% women). Each new antipsychotic user (n=35 339, 62.5% women) was matched with up to 15 non-users using incidence density sampling. MAIN OUTCOME MEASURES The main outcomes were stroke, venous thromboembolism, myocardial infarction, heart failure, ventricular arrhythmia, fracture, pneumonia, and acute kidney injury, stratified by periods of antipsychotic use, with absolute risks calculated using cumulative incidence in antipsychotic users versus matched comparators. An unrelated (negative control) outcome of appendicitis and cholecystitis combined was also investigated to detect potential unmeasured confounding. RESULTS Compared with non-use, any antipsychotic use was associated with increased risks of all outcomes, except ventricular arrhythmia. Current use (90 days after a prescription) was associated with elevated risks of pneumonia (hazard ratio 2.19, 95% confidence interval (CI) 2.10 to 2.28), acute kidney injury (1.72, 1.61 to 1.84), venous thromboembolism (1.62, 1.46 to 1.80), stroke (1.61, 1.52 to 1.71), fracture (1.43, 1.35 to 1.52), myocardial infarction (1.28, 1.15 to 1.42), and heart failure (1.27, 1.18 to 1.37). No increased risks were observed for the negative control outcome (appendicitis and cholecystitis). In the 90 days after drug initiation, the cumulative incidence of pneumonia among antipsychotic users was 4.48% (4.26% to 4.71%) versus 1.49% (1.45% to 1.53%) in the matched cohort of non-users (difference 2.99%, 95% CI 2.77% to 3.22%). CONCLUSIONS Antipsychotic use compared with non-use in adults with dementia was associated with increased risks of stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury, but not ventricular arrhythmia. The range of adverse outcomes was wider than previously highlighted in regulatory alerts, with the highest risks soon after initiation of treatment.
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Affiliation(s)
- Pearl L H Mok
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Matthew J Carr
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Daniel R Morales
- Population Health and Genomics, University of Dundee, Dundee, UK
| | - Aziz Sheikh
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel A Elliott
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Manchester Centre for Health Economics, Division of Population Health, Manchester, UK
| | - Elizabeth M Camacho
- Manchester Centre for Health Economics, Division of Population Health, Manchester, UK
| | - Tjeerd van Staa
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Anthony J Avery
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Centre for Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
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Karnik SJ, Margetts TJ, Wang HS, Movila A, Oblak AL, Fehrenbacher JC, Kacena MA, Plotkin LI. Mind the Gap: Unraveling the Intricate Dance Between Alzheimer's Disease and Related Dementias and Bone Health. Curr Osteoporos Rep 2024; 22:165-176. [PMID: 38285083 PMCID: PMC10912190 DOI: 10.1007/s11914-023-00847-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE OF REVIEW This review examines the linked pathophysiology of Alzheimer's disease/related dementia (AD/ADRD) and bone disorders like osteoporosis. The emphasis is on "inflammaging"-a low-level inflammation common to both, and its implications in an aging population. RECENT FINDINGS Aging intensifies both ADRD and bone deterioration. Notably, ADRD patients have a heightened fracture risk, impacting morbidity and mortality, though it is uncertain if fractures worsen ADRD. Therapeutically, agents targeting inflammation pathways, especially Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) and TNF-α, appear beneficial for both conditions. Additionally, treatments like Sirtuin 1 (SIRT-1), known for anti-inflammatory and neuroprotective properties, are gaining attention. The interconnectedness of AD/ADRD and bone health necessitates a unified treatment approach. By addressing shared mechanisms, we can potentially transform therapeutic strategies, enriching our understanding and refining care in our aging society. This review article is part of a series of multiple manuscripts designed to determine the utility of using artificial intelligence for writing scientific reviews.
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Affiliation(s)
- Sonali J Karnik
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Tyler J Margetts
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Hannah S Wang
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Alexandru Movila
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN, 46202, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Adrian L Oblak
- Department of Radiology & Imaging Sciences, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Jill C Fehrenbacher
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Melissa A Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, 46202, USA.
| | - Lilian I Plotkin
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, 46202, USA.
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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Langlais AL, Mountain RV, Kunst RF, Barlow D, Houseknecht KL, Motyl KJ. Thermoneutral housing does not rescue olanzapine-induced trabecular bone loss in C57BL/6J female mice. Biochimie 2023; 210:50-60. [PMID: 37236340 PMCID: PMC10357956 DOI: 10.1016/j.biochi.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023]
Abstract
Antipsychotic drugs are prescribed to a wide range of individuals to treat mental health conditions including schizophrenia. However, antipsychotic drugs cause bone loss and increase fracture risk. We previously found that the atypical antipsychotic (AA) drug risperidone causes bone loss through multiple pharmacological mechanisms, including activation of the sympathetic nervous system in mice treated with clinically relevant doses. However, bone loss was dependent upon housing temperature, which modulates sympathetic activity. Another AA drug, olanzapine, has substantial metabolic side effects, including weight gain and insulin resistance, but it is unknown whether bone and metabolic outcomes of olanzapine are also dependent upon housing temperature in mice. We therefore treated eight week-old female mice with vehicle or olanzapine for four weeks, housed at either room temperature (23 °C) or thermoneutrality (28-30 °C), which has previously been shown to be positive for bone. Olanzapine caused significant trabecular bone loss (-13% BV/TV), likely through increased RANKL-dependent osteoclast resorption, which was not suppressed by thermoneutral housing. Additionally, olanzapine inhibited cortical bone expansion at thermoneutrality, but did not alter cortical bone expansion at room temperature. Olanzapine also increased markers of thermogenesis within brown and inguinal adipose depots independent of housing temperature. Overall, olanzapine causes trabecular bone loss and inhibits the positive effect of thermoneutral housing on bone. Understanding how housing temperature modulates the impact of AA drugs on bone is important for future pre-clinical studies, as well as for the prescription of AA drugs, particularly to older adults and adolescents who are most vulnerable to the effects on bone.
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Affiliation(s)
- Audrie L Langlais
- Center for Molecular Medicine, MaineHealth Institute for Research, MaineHealth, Scarborough, ME, USA; Graduate School of Biomedical Science and Engineering, University of Maine, Orono, ME, USA
| | - Rebecca V Mountain
- Center for Molecular Medicine, MaineHealth Institute for Research, MaineHealth, Scarborough, ME, USA
| | - Roni F Kunst
- Center for Molecular Medicine, MaineHealth Institute for Research, MaineHealth, Scarborough, ME, USA
| | - Deborah Barlow
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Karen L Houseknecht
- Graduate School of Biomedical Science and Engineering, University of Maine, Orono, ME, USA; Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Katherine J Motyl
- Center for Molecular Medicine, MaineHealth Institute for Research, MaineHealth, Scarborough, ME, USA; Graduate School of Biomedical Science and Engineering, University of Maine, Orono, ME, USA; Tufts University School of Medicine, Tufts University, Boston, MA, USA.
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Weerasinghe DK, Hodge JM, Pasco JA, Samarasinghe RM, Azimi Manavi B, Williams LJ. Antipsychotic-induced bone loss: the role of dopamine, serotonin and adrenergic receptor signalling. Front Cell Dev Biol 2023; 11:1184550. [PMID: 37305679 PMCID: PMC10248006 DOI: 10.3389/fcell.2023.1184550] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Antipsychotics are commonly used in treating psychiatric disorders. These medications primarily target dopamine the serotonin receptors, they have some affinity to adrenergic, histamine, glutamate and muscarinic receptors. There is clinical evidence that antipsychotic use decreases BMD and increases fracture risk, with dopamine, serotonin and adrenergic receptor-signalling becoming an increasing area of focus where the presence of these receptors in osteoclasts and osteoblasts have been demonstrated. Osteoclasts and osteoblasts are the most important cells in the bone remodelling and the bone regeneration process where the activity of these cells determine the bone resorption and formation process in order to maintain healthy bone. However, an imbalance in osteoclast and osteoblast activity can lead to decreased BMD and increased fracture risk, which is also believed to be exacerbated by antipsychotics use. Therefore, the aim of this review is to provide an overview of the mechanisms of action of first, second and third generation antipsychotics and the expression profiles of dopamine, serotonin and adrenergic receptors during osteoclastogenesis and osteoblastogenesis.
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Affiliation(s)
- D. Kavindi Weerasinghe
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Jason M. Hodge
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
| | - Julie A. Pasco
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine—Western Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rasika M. Samarasinghe
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Behnaz Azimi Manavi
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Lana J. Williams
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
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Prevention and management of behavioural and psychological symptoms in patients with dementia in acute care: a best practice implementation project. JBI Evid Implement 2022; 20:289-300. [PMID: 36375022 PMCID: PMC9794137 DOI: 10.1097/xeb.0000000000000329] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Behavioural and psychological symptoms of dementia are very common in acute care. Agitation and aggressive behaviours are the most common symptoms and are challenging to manage. Early detection and a nonpharmacological approach are recommended. OBJECTIVES To implement evidence-based recommendations for the prevention and management of aggression/agitation in patients with dementia in an acute geriatric care unit. METHODS The project used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit was conducted with seven audit criteria based on evidence summaries. It was followed by the implementation of an action plan and a follow-up audit. RESULTS Results showed moderate improvements in compliance with best practice recommendations. The second audit indicated an improvement up to 46% with the identification of factors/triggers that precipitate aggression/agitation and completion of a risk assessment. The highest improvement was the training of the nursing team (79%). Compliance with the involvement of patients and their families in the care planning improved slightly (14%). The lowest improvement was for the development and implementation of individualized care plans (10%). CONCLUSION The project implementation achieved some positive changes. A formalized process for preventing aggression/agitation is in place. The interprofessional collaboration, the support given to the nursing team and the basket of nonpharmacological interventions were strengthened. The electronic documentation and a limited collaboration of the nursing team were challenging. As further strategies were implemented, further audit would be required to assess achievement in change and/or demonstration of improved care provided for this vulnerable population.
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Hwang YJ, Alexander GC, An H, Moore TJ, Mehta HB. Risk of Hospitalization and Death Associated With Pimavanserin Use in Older Adults With Parkinson Disease. Neurology 2021; 97:e1266-e1275. [PMID: 34389652 DOI: 10.1212/wnl.0000000000012601] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/12/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the risk of hospitalization and death associated with pimavanserin use. METHODS We conducted a retrospective cohort study of adults 65 years and older with Parkinson's disease between November 1, 2015 and December 31, 2018 using an administrative dataset on residents of Medicare-certified long-term care facilities and linked Medicare claims data. Propensity score-based inverse probability of treatment weighting (IPTW) was used to balance pimavanserin users and nonusers on 24 baseline characteristics. Fine-Gray competing risk and Cox proportional hazards regression models were used to estimate the risk of hospitalization and death up to one year, respectively. RESULTS The study cohort included 2,186 pimavanserin users and 18,212 nonusers. There was a higher risk of 30-day hospitalization with pimavanserin use vs. nonuse (IPTW adjusted hazard ratio [aHR] 1.24, 95% confidence intervals [CI] 1.06-1.43). There was no association of pimavanserin use with 90-day hospitalization (aHR 1.10, CI 0.99-1.24) nor with 30-day mortality (aHR 0.76, CI 0.56-1.03). Pimavanserin use vs. nonuse was associated with an increased 90-day mortality (aHR 1.20, CI 1.02-1.41) that persisted after 180 days (aHR 1.28, CI 1.13-1.45) and 1 year (aHR 1.56, CI 1.42-1.72). CONCLUSIONS Pimavanserin use vs. nonuse in older adults was associated with an increased risk of hospitalization at one month of initiation and a higher risk of death for up to one year following initiation. These findings, in a large real-world cohort within long-term care facilities, may help to inform decisions regarding its risk-benefit balance among patients with Parkinson's disease. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with Parkinson's disease who are 65 or older and residing in Medicare-certified long-term care facilities, pimavanserin prescribing is associated with an increased risk of 30-day hospitalization and higher 90-, 180-, and, 365-day mortality.
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Affiliation(s)
- Y Joseph Hwang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD .,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD
| | - G Caleb Alexander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Huijun An
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Thomas J Moore
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD.,Institute for Safe Medication Practices, Alexandria, VA.,Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Hemalkumar B Mehta
- Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Fedecostante M, Onder G, Eusebi P, Dell'Aquila G, Zengarini E, Carrieri B, Manes Gravina E, Falsiroli C, Corsonello A, Luzi R, Lattanzio F, Bernabei R, Cherubini A. Predictors of Functional Decline in Nursing Home Residents: The Shelter Project. J Gerontol A Biol Sci Med Sci 2021; 75:1600-1605. [PMID: 31858108 DOI: 10.1093/gerona/glz296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of our study was to identify independent predictors of functional decline in older nursing home (NH) residents, taking into account both resident and facility characteristics. METHODS Longitudinal observational study involving 1,760 older (≥65 y) residents of NH participating in the SHELTER* study (57 NH in eight countries). All residents underwent a comprehensive geriatric assessment using the interRAI LTCF. Functional decline was defined as an increase of at least one point in the MDS Long Form ADL scale during a 1 year follow-up. Facility and country effects were taken into account. RESULTS During the study period 891 (50.6%), NH residents experienced ADL decline. Residents experiencing ADL decline were older, had lower disability at baseline, were more frequently affected by severe dementia and by urinary incontinence, and used more antipsychotics. In the mixed-effect logistic regression model, factors independently associated with a higher risk of functional decline were dementia and urinary incontinence, whereas the presence of a geriatrician was a protective factor. CONCLUSIONS Both resident and facility characteristics are associated with the risk of functional decline in NH residents. Increasing the quality of healthcare by involving a geriatrician in residents' care might be an important strategy to improve the outcome of this vulnerable population.
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Affiliation(s)
- Massimiliano Fedecostante
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy e Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Eusebi
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Giuseppina Dell'Aquila
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Elisa Zengarini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Barbara Carrieri
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy.,Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Ester Manes Gravina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy e Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cinzia Falsiroli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy e Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology and Clinical Laboratory, IRCCS INRCA, Cosenza, Italy
| | | | | | - Roberto Bernabei
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Italy e Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
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Kuo CM, Liao WJ, Huang CC, Lan TH, Lin CH, Wang SP, Lee CH, Lui PW. Antipsychotic Medication in Schizophrenic Patients is Associated with Higher Risks of Developing Bone Fractures and Refractures. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:562-570. [PMID: 33124588 PMCID: PMC7609221 DOI: 10.9758/cpn.2020.18.4.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/20/2020] [Accepted: 05/27/2020] [Indexed: 11/21/2022]
Abstract
Objective The relationship of antipsychotics and the risk of refracture in treated patients is unclear. The aim of this study is to evaluate the association between prolonged antipsychotic and the incidences of bone fractures and refractures in schizophrenia. Methods This is a retrospective nested case-control study using Taiwan National Health Insurance Research Database recorded from 2000 to 2005, with cases followed up to end of 2011. Total of 7,842 schizophrenic patients, 3,955 had developed bone fractures were compared with 3,887 control subjects matched in age, sex, and index date. Antipsychotic drug exposure was classified based on the drug type and medication duration. Conditional logistic regression analyses were performed. Odds ratio (OR) and confidence interval (CI) were calculated. Results We found (after adjustments) higher risks of developing fractures under continued use of typical (OR = 1.70; 95% CI, 1.51−1.91) or atypical antipsychotics (OR = 1.43; 95% CI, 1.28−1.60) were found. Additionally, continued use typical (OR = 1.84; 95% CI, 1.35−2.50) or atypical antipsychotics (OR = 1.44; 95% CI, 1.06−1.95) was positively associated with refracture risks. Moreover, refractures were associated with continuous use of chlorpromazine (one typical antipsychotics, OR = 2.45; 95% CI, 1.14−5.25), and risperidone (OR = 1.48; 95% CI, 1.01−2.16) or zotepine (OR = 2.15; 95% CI, 1.06−4.36) (two atypical antipsychotics). Conclusion Higher risks of bone fracture and refracture were found in schizophrenia under prolonged medication with typical or atypical antipsychotics. We therefore recommend that clinicians should pay more attention on bone density monitoring for patients using long-term antipsychotics.
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Affiliation(s)
- Ching-Min Kuo
- Departments of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Jen Liao
- Departments of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Che Huang
- Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan.,Health Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsuo-Hung Lan
- Departments of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan.,Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
| | - Ching-Heng Lin
- Health Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shun-Ping Wang
- Departments of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Sports Recreation and Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, Taiwan
| | - Cheng-Hung Lee
- Departments of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ping-Wing Lui
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan.,Office of Superintendent, Saint Paul Hospital, Taoyuan, Taiwan
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11
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Factors That Predict 1-Year Incident Hip and Non-Hip Fractures for Home Care Recipients: A Linked-Data Retrospective Cohort Study. J Am Med Dir Assoc 2020; 22:1035-1042. [PMID: 33008757 DOI: 10.1016/j.jamda.2020.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The purpose of our study was to identify factors that predict 1-year incident hip and major osteoporotic non-hip fractures (ie, wrist, spine, pelvis, humerus) for home care recipients while accounting for the competing risk of death. DESIGN We conducted a retrospective cohort study with linked population data. SETTING AND PARTICIPANTS All home care recipients in Ontario, Canada, receiving services for more than 6 months with an admission assessment between April 1, 2011, and March 31, 2015, were included. METHODS Clinical data from the Resident Assessment Instrument Home Care were linked to fracture data from the Discharge Abstract Database and the National Acute Care Reporting System. Competing risk proportional hazard regressions using the Fine and Grey method were performed to model the association between potential risk factors and fracture. RESULTS Previous fall, previous fracture, cognitive impairment, unsteady gait, alcohol use, tobacco use, and Parkinson disease were consistently associated with all fracture types. Cognitive impairment (hazard ratio 2.09; 95% confidence interval 1.86-2.36) and wandering [1.66 (1.06-1.27)] were most predictive of hip fractures and being female [1.86 (1.76-1.98)] and experiencing a previous fracture [1.86 (1.76-1.98)] were most predictive of non-hip fractures. Risk factors unique to non-hip fractures as compared with hip fractures were locomotion ability outdoors and psychotropic medication use. CONCLUSIONS AND IMPLICATIONS Our results indicate that, in addition to typical fracture risk factors, home care recipients have unique characteristics that increase their risk. Fracture risk assessment tools and subsequent prevention strategies should be modified to accurately identify home care recipients at risk for imminent 1-year fracture.
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12
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Tapiainen V, Lavikainen P, Koponen M, Taipale H, Tanskanen A, Tiihonen J, Hartikainen S, Tolppanen A. The Risk of Head Injuries Associated With Antipsychotic Use Among Persons With Alzheimer's disease. J Am Geriatr Soc 2020; 68:595-602. [DOI: 10.1111/jgs.16275] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Vesa Tapiainen
- School of PharmacyUniversity of Eastern Finland Kuopio Finland
- Kuopio Research Centre of Geriatric CareUniversity of Eastern Finland Kuopio Finland
| | - Piia Lavikainen
- School of PharmacyUniversity of Eastern Finland Kuopio Finland
| | - Marjaana Koponen
- School of PharmacyUniversity of Eastern Finland Kuopio Finland
- Kuopio Research Centre of Geriatric CareUniversity of Eastern Finland Kuopio Finland
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash University Parkville Victoria Australia
| | - Heidi Taipale
- School of PharmacyUniversity of Eastern Finland Kuopio Finland
- Kuopio Research Centre of Geriatric CareUniversity of Eastern Finland Kuopio Finland
- Department of Clinical NeuroscienceKarolinska Institutet Stockholm Sweden
- Department of Forensic PsychiatryNiuvanniemi Hospital, University of Eastern Finland Kuopio Finland
| | - Antti Tanskanen
- Department of Clinical NeuroscienceKarolinska Institutet Stockholm Sweden
- Department of Forensic PsychiatryNiuvanniemi Hospital, University of Eastern Finland Kuopio Finland
- Impact Assessment UnitNational Institute for Health and Welfare Helsinki Finland
| | - Jari Tiihonen
- Department of Clinical NeuroscienceKarolinska Institutet Stockholm Sweden
- Department of Forensic PsychiatryNiuvanniemi Hospital, University of Eastern Finland Kuopio Finland
| | - Sirpa Hartikainen
- School of PharmacyUniversity of Eastern Finland Kuopio Finland
- Kuopio Research Centre of Geriatric CareUniversity of Eastern Finland Kuopio Finland
| | - Anna‐Maija Tolppanen
- School of PharmacyUniversity of Eastern Finland Kuopio Finland
- Kuopio Research Centre of Geriatric CareUniversity of Eastern Finland Kuopio Finland
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13
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Antipsychotic therapies and bone health. Case Rep Womens Health 2020; 25:e00160. [PMID: 31867222 PMCID: PMC6906724 DOI: 10.1016/j.crwh.2019.e00160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 11/20/2022] Open
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14
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May M, Beauchemin M, Vary C, Barlow D, Houseknecht KL. The antipsychotic medication, risperidone, causes global immunosuppression in healthy mice. PLoS One 2019; 14:e0218937. [PMID: 31242264 PMCID: PMC6594635 DOI: 10.1371/journal.pone.0218937] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/12/2019] [Indexed: 01/19/2023] Open
Abstract
Atypical antipsychotic medications such as risperidone are widely prescribed for diverse psychiatric indications including schizophrenia, bipolar disorder and depression. These medications have complex pharmacology and are associated with significant endocrine and metabolic side effects. This class of medications also carries FDA black box warnings due to increased risk of death in elderly patients. Clinical reports indicate that patients treated with these medications are more susceptible to infections; however, the underlying mechanisms/pharmacology are unclear. We have previously reported that risperidone and it’s active metabolite distributes to the bone marrow in clinically relevant concentrations in preclinical species, leading us to hypothesize that the hematopoietic system may be impacted by these medications. To test this hypothesis, using proteomic and cytokine array technology, we evaluated the expression of genes involved in inflammatory and immune function following short term (5 days) and longer term (4 weeks) treatment in healthy animals. We report that low-dose risperidone treatment results in global immunosuppression in mice, observed following 5 days of dosing and exacerbated with longer term drug treatment (4 weeks). These data are consistent with increased susceptibility to infection in patients administered these medications and have profound implications for the increasing off-label prescribing to vulnerable patient populations including children and the elderly.
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Affiliation(s)
- Meghan May
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, United States of America
| | - Megan Beauchemin
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, United States of America
| | - Calvin Vary
- Center for Molecular Medicine, Maine Medical Center Research Institute, Scarborough, ME, United States of America
| | - Deborah Barlow
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, United States of America
| | - Karen L. Houseknecht
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, United States of America
- * E-mail:
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15
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Abstract
Dizziness is a common symptom encountered by all physicians. Dizziness and related symptoms are frequently linked to 1 or more of a list of contributors that includes benign paroxysmal positional vertigo, Ménière disease, migraine, acute peripheral vestibulopathy, cerebral ischemia, and anxiety disorders. Awareness of these common clinical patterns increases the likelihood of making a rapid, accurate diagnosis.
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16
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Papola D, Ostuzzi G, Thabane L, Guyatt G, Barbui C. Antipsychotic drug exposure and risk of fracture: a systematic review and meta-analysis of observational studies. Int Clin Psychopharmacol 2018; 33:181-196. [PMID: 29688914 DOI: 10.1097/yic.0000000000000221] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
To investigate the extent to which exposure to first-generation and second-generation antipsychotics (APs) is associated with an increased risk of fractures, with a particular focus on hip fractures, and to ascertain the risk associated with exposure to individual drugs. We included observational studies that reported data on fractures in individuals exposed to APs compared with unexposed individuals or individuals with previous exposure. We extracted information on study design, source of data, population characteristics, outcomes of interest, matching and confounding factors, and used a modified version of the Newcastle-Ottawa Scale to judge study risk of bias. We pooled adjusted estimates of relative effects to generate pooled odds ratios (ORs) and their 95% confidence interval (CI) using a random-effects model. We rated the quality of evidence using the GRADE approach. Of 36 observational studies, 29 proved to have a low risk of bias and seven were found to have a high risk of bias. The risk of hip fracture (OR: 1.57, 95% CI: 1.42-1.74, low quality of evidence) and of any fracture (OR: 1.17, 95% CI: 1.04-1.31, very low quality of evidence) increased with exposure to APs, with similar increases in risk in the first generation and second generation. The risk was similar among different diagnostic categories. The few studies that provided data were insufficient to allow inferences on individual drugs. AP exposure in unselected populations was associated with a 57% increase in the risk of hip fractures and a 17% increase in the risk of any fractures. Between-study heterogeneity limits the confidence in this estimate.
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Affiliation(s)
- Davide Papola
- Department of Neuroscience, Biomedicine and Movement Science, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine and Movement Science, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Science, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy
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17
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Houseknecht KL, Bouchard CC, Black CA. Elucidating the Mechanism(s) Underlying Antipsychotic and Antidepressant-Mediated Fractures. ACTA ACUST UNITED AC 2017; 1:9-13. [PMID: 31008454 PMCID: PMC6469345 DOI: 10.29245/2578-2959/2018/1.1106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mood spectrum disorders and medications used to treat these disorders, such as atypical antipsychotic drugs (AA), are associated with metabolic and endocrine side effects including obesity, dyslipidemia, hyperglycemia and increased risk of fractures. Antidepressant medications, including selective serotonin reuptake inhibitors (SSRI), have also been reported to increase fracture risk in some patients. The pharmacology underlying the increased risk of fractures is currently unknown. Possible mechanisms include alternations in dopaminergic and/or serotonergic signaling pathways. As these medications distribute to the bone marrow as well as to the brain, it is possible that drug-induced fractures are due to both centrally mediated effects as well as direct effects on bone turnover. Given the growing patient population that is prescribed these medications for both on- and off-label indications, understanding the level of risk and the mechanisms underlying drug-induced fractures is important for informing both prescribing and patient monitoring practices.
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Affiliation(s)
- Karen L Houseknecht
- College of Osteopathic Medicine, University of New England, 11 Hills Beach Road, Biddeford, ME 04005, USA.,College of Pharmacy, University of New England, 11 Hills Beach Road, Biddeford, ME 04005 USA
| | - C C Bouchard
- College of Osteopathic Medicine, University of New England, 11 Hills Beach Road, Biddeford, ME 04005, USA
| | - C A Black
- College of Pharmacy, University of New England, 11 Hills Beach Road, Biddeford, ME 04005 USA
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18
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Motyl KJ, Beauchemin M, Barlow D, Le PT, Nagano K, Treyball A, Contractor A, Baron R, Rosen CJ, Houseknecht KL. A novel role for dopamine signaling in the pathogenesis of bone loss from the atypical antipsychotic drug risperidone in female mice. Bone 2017; 103:168-176. [PMID: 28689816 PMCID: PMC5573184 DOI: 10.1016/j.bone.2017.07.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/30/2017] [Accepted: 07/05/2017] [Indexed: 01/19/2023]
Abstract
Atypical antipsychotic (AA) drugs, including risperidone (RIS), are used to treat schizophrenia, bipolar disorder, and autism, and are prescribed off-label for other mental health issues. AA drugs are associated with severe metabolic side effects of obesity and type 2 diabetes. Cross-sectional and longitudinal data also show that risperidone causes bone loss and increases fracture risk in both men and women. There are several potential mechanisms of bone loss from RIS. One is hypogonadism due to hyperprolactinemia from dopamine receptor antagonism. However, many patients have normal prolactin levels; moreover we demonstrated that bone loss from RIS in mice can be blocked by inhibition of β-adrenergic receptor activation with propranolol, suggesting the sympathetic nervous system (SNS) plays a pathological role. Further, when, we treated ovariectomized (OVX) and sham operated mice daily for 8weeks with RIS or vehicle we demonstrated that RIS causes significant trabecular bone loss in both sham operated and OVX mice. RIS directly suppressed osteoblast number in both sham and OVX mice, but increased osteoclast number and surface in OVX mice alone, potentially accounting for the augmented bone loss. Thus, hypogonadism alone cannot explain RIS induced bone loss. In the current study, we show that dopamine and RIS are present in the bone marrow compartment and that RIS can exert its effects directly on bone cells via dopamine receptors. Our findings of both direct and indirect effects of AA drugs on bone are relevant for current and future clinical and translational studies investigating the mechanism of skeletal changes from AA drugs.
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Affiliation(s)
- Katherine J Motyl
- Center for Molecular Medicine, Maine Medical Center Research Institute, Maine Medical Center, Scarborough, ME, USA
| | - Megan Beauchemin
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Deborah Barlow
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Phuong T Le
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Maine Medical Center, Scarborough, ME, USA
| | - Kenichi Nagano
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Annika Treyball
- Center for Molecular Medicine, Maine Medical Center Research Institute, Maine Medical Center, Scarborough, ME, USA
| | - Anisha Contractor
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA
| | - Roland Baron
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Clifford J Rosen
- Center for Clinical and Translational Research, Maine Medical Center Research Institute, Maine Medical Center, Scarborough, ME, USA
| | - Karen L Houseknecht
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA.
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19
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Berry SD, Zullo AR, McConeghy K, Lee Y, Daiello L, Kiel DP. Defining hip fracture with claims data: outpatient and provider claims matter. Osteoporos Int 2017; 28:2233-2237. [PMID: 28447106 PMCID: PMC5649370 DOI: 10.1007/s00198-017-4008-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Medicare claims are commonly used to identify hip fractures, but there is no universally accepted definition. We found that a definition using inpatient claims identified fewer fractures than a definition including outpatient and provider claims. Few additional fractures were identified by including inconsistent diagnostic and procedural codes at contiguous sites. INTRODUCTION Medicare claims data is commonly used in research studies to identify hip fractures, but there is no universally accepted definition of fracture. Our purpose was to describe potential misclassification when hip fractures are defined using Medicare Part A (inpatient) claims without considering Part B (outpatient and provider) claims and when inconsistent diagnostic and procedural codes occur at contiguous fracture sites (e.g., femoral shaft or pelvic). METHODS Participants included all long-stay nursing home residents enrolled in Medicare Parts A and B fee-for-service between 1/1/2008 and 12/31/2009 with follow-up through 12/31/2011. We compared the number of hip fractures identified using only Part A claims to (1) Part A plus Part B claims and (2) Part A and Part B claims plus discordant codes at contiguous fracture sites. RESULTS Among 1,257,279 long-stay residents, 40,932 (3.2%) met the definition of hip fracture using Part A claims, and 41,687 residents (3.3%) met the definition using Part B claims. 4566 hip fractures identified using Part B claims would not have been captured using Part A claims. An additional 227 hip fractures were identified after considering contiguous fracture sites. CONCLUSIONS When ascertaining hip fractures, a definition using outpatient and provider claims identified 11% more fractures than a definition with only inpatient claims. Future studies should publish their definition of fracture and specify if diagnostic codes from contiguous fracture sites were used.
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Affiliation(s)
- S D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St. Suite 1A, Boston, MA, 02215, USA.
- Hebrew SeniorLife, Institute for Aging Research, Hebrew Rehabilitation Center, 1200 Centre Street, Roslindale, MA, 02131, USA.
| | - A R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - K McConeghy
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Y Lee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - L Daiello
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - D P Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St. Suite 1A, Boston, MA, 02215, USA
- Hebrew SeniorLife, Institute for Aging Research, Hebrew Rehabilitation Center, 1200 Centre Street, Roslindale, MA, 02131, USA
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20
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Wei YJ, Simoni-Wastila L, Lucas JA, Brandt N. Fall and Fracture Risk in Nursing Home Residents With Moderate-to-Severe Behavioral Symptoms of Alzheimer's Disease and Related Dementias Initiating Antidepressants or Antipsychotics. J Gerontol A Biol Sci Med Sci 2017; 72:695-702. [PMID: 27247274 DOI: 10.1093/gerona/glw095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 05/10/2016] [Indexed: 11/14/2022] Open
Abstract
Background Both antidepressants and antipsychotics are used in older adults with behavioral symptoms of Alzheimer's disease and related dementias. Despite the prevalent use of these agents, little is known about their comparative risks for falls and fractures. Methods Using 2007-2009 Medicare claims data linked to Minimum Data Set 2.0, we identified new users of antidepressants and antipsychotics among nursing home residents with Alzheimer's disease and related dementias who had moderate-to-severe behavioral symptoms. Separate discrete-time survival models were used to estimate risks of falls, fractures, and a composite of both among antidepressant group versus antipsychotic group. Results Compared to antipsychotic users, antidepressant users experienced significantly higher risk for fractures (adjusted hazard ratio = 1.35, 95% confidence interval = 1.10-1.66). The overall risk of falls or fractures remained significant in the antidepressant versus antipsychotic group (adjusted hazard ratio = 1.16, 95% confidence interval = 1.02-1.32). Conclusions Antidepressants are associated with higher fall and fracture risk compared to antipsychotics in the management of older adults with Alzheimer's disease and related dementias who experience moderate-to-severe behavioral symptoms. Clinicians need to assess the ongoing risks/benefits of antidepressants for these symptoms especially in light of the increasingly prevalent use of these agents.
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Affiliation(s)
- Yu-Jung Wei
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore.,Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore
| | - Judith A Lucas
- Department of Behavioral and Community Health, Seton Hall University College of Nursing, South Orange, New Jersey
| | - Nicole Brandt
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore
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21
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Lee SH, Hsu WT, Lai CC, Esmaily-Fard A, Tsai YW, Chiu CC, Wang J, Chang SS, Lee CC. Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis. Osteoporos Int 2017; 28:1167-1178. [PMID: 28083669 DOI: 10.1007/s00198-016-3881-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/11/2016] [Indexed: 01/19/2023]
Abstract
UNLABELLED 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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Affiliation(s)
- S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan
| | - W-T Hsu
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - C-C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - A Esmaily-Fard
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y-W Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital, University College of Medicine, Taoyuan, Taiwan
| | - C-C Chiu
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
| | - J Wang
- University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | - S-S Chang
- Department of Family Medicine, Chang Gung Memorial Hospital, No.5. Fu-Hsing street, Kuei Shan Hsiang, Taoyuan, Hsien, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - C C Lee
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan.
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22
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Atypical Antipsychotics and the Risk of Falls and Fractures Among Older Adults: An Emulation Analysis and an Evaluation of Additional Confounding Control Strategies. J Clin Psychopharmacol 2017; 37:162-168. [PMID: 28225746 DOI: 10.1097/jcp.0000000000000647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this study was to investigate the risk of falls and fractures among older adults receiving atypical antipsychotics. METHODS An emulation analysis of a previously published study was performed using the US Truven MarketScan Medicare Supplemental database (MDCR). In addition, modified analyses were implemented to evaluate alternative confounding control strategies that (1) included all covariates used to fit propensity score models in outcome models and (2) required patients to have a mental health condition diagnosis and a health care visit within 90 days prior to the index date. FINDINGS The MDCR emulation analyses yielded similar results as the previous study. For the previous study and our emulation analysis, the results were: nonvertebral osteoporotic fractures (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.41-1.60; and OR, 1.49; 95% CI, 1.37-1.63, respectively), hip fractures (OR, 1.67; 95% CI, 1.53-1.81; and OR, 1.59; 95% CI, 1.43-1.77, respectively), any fracture (OR, 1.29; 95% CI, 1.24-1.34; and OR, 1.32; 95% CI, 1.23-1.41, respectively), and falls (OR, 1.54; 95% CI, 1.47-1.61; and OR, 1.45; 95% CI, 1.11-1.89, respectively). However, in modified analyses, no associations were significant. The primary change that resulted in the attenuation of associations was the requirement for patients to have a mental health condition diagnosis and a health care visit prior to the index date. CONCLUSIONS Our MDCR emulation analysis yielded similar results as a previous study; however, in modified analyses, the associations between fractures and falls and atypical antipsychotics were no longer significant. The contrast of results between the emulation and modified analyses may be due to the analytic approach used to compare patients (and potential confounding by indication). Further research is warranted to evaluate these associations.
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Cadwell S, Dearmon V, VandeWaa EA. Reducing Falls in Residents With Dementia by Reducing Psychotropic Medication Use: Does It Work? J Nurse Pract 2017. [DOI: 10.1016/j.nurpra.2016.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bakken MS, Schjøtt J, Engeland A, Engesaeter LB, Ruths S. Antipsychotic Drugs and Risk of Hip Fracture in People Aged 60 and Older in Norway. J Am Geriatr Soc 2016; 64:1203-9. [DOI: 10.1111/jgs.14162] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Marit S. Bakken
- Department of Global Public Health and Primary Care; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
- Kavli Research Centre for Geriatrics and Dementia; Haraldsplass Deaconess Hospital; Bergen Norway
| | - Jan Schjøtt
- Department of Clinical Science; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
- Section of Clinical Pharmacology; Laboratory of Clinical Biochemistry; Haukeland University Hospital; Bergen Norway
- Regional Medicines Information and Pharmacovigilance Centre; Haukeland University Hospital; Bergen Norway
| | - Anders Engeland
- Department of Global Public Health and Primary Care; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
- Department of Pharmacoepidemiology; Norwegian Institute of Public Health; Oslo Norway
| | - Lars B. Engesaeter
- Department of Clinical Science; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
- Norwegian Arthroplasty Registry; Department of Orthopaedics and Department of Clinical Medicine; Haukeland University Hospital; Bergen Norway
| | - Sabine Ruths
- Department of Global Public Health and Primary Care; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
- Research Unit for General Practice; Uni Research Health; Bergen Norway
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Wynaden D, Tohotoa J, Heslop K, Al Omari O. Recognising falls risk in older adult mental health patients and acknowledging the difference from the general older adult population. Collegian 2016; 23:97-102. [PMID: 27188045 DOI: 10.1016/j.colegn.2014.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Older adults admitted to inpatient mental health units present with complex mental health care needs which are often compounded by the challenges of living with physical co-morbidities. They are a mobile population and a high risk group for falling during hospitalisation. To address quality and safety concerns around the increased risk for falls, a qualitative research study was completed to obtain an improved understanding of the factors that increase the risk of falling in this patient cohort. Focus groups were conducted with mental health professionals working across older adult mental health services in metropolitan Western Australia. Data were analysed using content analysis and three themes emerged that were significant concepts relevant to falls risk in this patient group. These themes were (1) limitations of using generic falls risk assessment and management tools, (2) assessment of falls risk not currently captured on standardised tools, and (3) population specific causes of falls. The findings demonstrate that older adult mental health patients are a highly mobile group that experience frequent changes in cognition, behaviour and mental state. The mix of patients with organic or functional psychiatric disorders within the same environment also presents complex and unique care challenges and multi-disciplinary collaboration is central to reduce the risk of falls. As this group of patients are also frequently admitted to both general inpatient and aged care settings, the findings are relevant to the assessment and management of falls risk across all health care settings.
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Heslop KR, Wynaden DG. Impact of falls on mental health outcomes for older adult mental health patients: An Australian study. Int J Ment Health Nurs 2016; 25:3-11. [PMID: 26603350 DOI: 10.1111/inm.12164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 06/11/2015] [Accepted: 08/02/2015] [Indexed: 01/17/2023]
Abstract
Sustaining a fall during hospitalization reduces a patient's ability to return home following discharge. It is well accepted that factors, such as alteration in balance, functional mobility, muscle strength, and fear of falling, are all factors that impact on the quality of life of elderly people following a fall. However, the impact that falls have on mental health outcomes in older adult mental health patients remains unexplored. The present study reports Health of the Nation Outcome Scale scores for people over the age of 65 (HoNOS65+), which were examined in a cohort of 65 patients who sustained a fall and 73 non-fallers admitted to an older adult mental health service (OAMHS). Results were compared with state and national HoNOS65+ data recorded in Australian National Outcome Casemix Collection data to explore the effect that sustaining a fall while hospitalized has on mental health outcomes. Australian state and national HoNOS65+ data indicate that older adults generally experience improved HoNOS65+ scores from admission to discharge. Mental health outcomes for patients who sustained a fall while admitted to an OAMHS did not follow this trend. Sustaining a fall while admitted to an OAMHS negatively affects discharge mental health outcomes.
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Affiliation(s)
- Karen Ruth Heslop
- Royal Perth Hospital.,School of Nursing and Midwifery, Curtin University
| | - Dianne Gaye Wynaden
- School of Nursing and Midwifery, Curtin University.,Fremantle Mental Health Services Perth, Western Australia, Australia
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El-Saifi N, Moyle W, Jones C, Tuffaha H. Quetiapine safety in older adults: a systematic literature review. J Clin Pharm Ther 2016; 41:7-18. [DOI: 10.1111/jcpt.12357] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 12/26/2015] [Indexed: 02/06/2023]
Affiliation(s)
- N. El-Saifi
- Menzies Health Institute Queensland; Griffith University; QLD Australia
| | - W. Moyle
- Menzies Health Institute Queensland; Griffith University; QLD Australia
| | - C. Jones
- Menzies Health Institute Queensland; Griffith University; QLD Australia
| | - H. Tuffaha
- Menzies Health Institute Queensland; Griffith University; QLD Australia
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Thaler HW, Sterke CS, van der Cammen TJM. Association of Proton Pump Inhibitor Use with Recurrent Falls and Risk of Fractures in Older Women: A Study of Medication Use in Older Fallers. J Nutr Health Aging 2016; 20:77-81. [PMID: 26728937 DOI: 10.1007/s12603-016-0679-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To examine the association between Proton pump inhibitors (PPIs) use and falls and fractures. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS 400 female patients aged 70 years or older who were consecutively admitted to the Trauma Center Meidling, Vienna, after a fall and who required hospital admission. METHODS We quantified the strength of the associations between PPI use and falls, and between PPI use and fractures, using a logistic regression. RESULTS use of PPIs was significantly associated with risk of recurrent falls (OR 1.92, 95% CI = 1.05 - 3.50, p = 0.04) as well as with risk of a fracture (OR 2.15, 95% CI 1.10 - 4.21, p = 0.03). CONCLUSIONS In conclusion, our results provide further evidence that PPI use may increase risk of falls and fractures in older women and highlight the need for clinicians to reassess the original indication and the need for continuation of PPIs on a regular basis.
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Affiliation(s)
- H W Thaler
- Tischa J.M. van der Cammen, MD, PhD, FRCP, Associate Professor of Geriatric Medicine, Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands, Tel: +31-10-703.59.79; Fax: +31-10-703.47.68, E-mail:
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Simmons M, Peraza-Smith GB, Harris M, Scanland S. Application of resources for non-pharmacological interventions to improve dementia care in nursing homes. Geriatr Nurs 2015; 36:242-4. [PMID: 26244181 DOI: 10.1016/j.gerinurse.2015.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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30
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Berry SD, Placide SG, Mostofsky E, Zhang Y, Lipsitz LA, Mittleman MA, Kiel DP. Antipsychotic and Benzodiazepine Drug Changes Affect Acute Falls Risk Differently in the Nursing Home. J Gerontol A Biol Sci Med Sci 2015; 71:273-8. [PMID: 26248560 DOI: 10.1093/gerona/glv091] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/21/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Psychotropic drugs increase the risk of falls, but they are still frequently prescribed to treat behavioral symptoms associated with dementia in the nursing home. We examined whether there is an acute increased risk of falls in the days following a change to an antipsychotic or benzodiazepine drug prescription. METHODS We collected information on 594 long-stay nursing home residents from two facilities who fell at least once between September 1, 2010 and May 31, 2013. Psychotropic drug changes were ascertained from the facilities' computerized medication administration log. We used the case-crossover design to compare the frequency of antipsychotic and benzodiazepine drug changes during the days before a fall with the frequency of drug changes at more remote times. RESULTS Mean age was 87.5 years, and 75.1% were female. The risk of falls was higher in the 24 hours following benzodiazepine initiation compared with other times (odds ratio [OR] 3.79, 95% confidence interval [CI] 1.10, 13.00). There was no clear difference in risk following antipsychotic initiation (OR 2.42, CI 0.58, 10.06), but this could be due to the small sample size. Stopping a benzodiazepine was associated with a significantly reduced fall risk (OR 0.26, 95% CI 0.08-0.91). CONCLUSIONS Benzodiazepines pose an immediate threat to fall risk, whereas it is less clear if antipsychotics also pose an immediate risk. Nursing home staff should be particularly vigilant in the days following the new prescription for a benzodiazepine in an effort to prevent injury.
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Affiliation(s)
- Sarah D Berry
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
| | | | - Elizabeth Mostofsky
- Department of Medicine, Beth Israel Deaconess Medical Center Cardiovascular Epidemiology Research Unit, Boston, Massachusetts
| | - Yuqing Zhang
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts
| | - Lewis A Lipsitz
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Murray A Mittleman
- Department of Medicine, Beth Israel Deaconess Medical Center Cardiovascular Epidemiology Research Unit, Boston, Massachusetts
| | - Douglas P Kiel
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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Motyl KJ, DeMambro VE, Barlow D, Olshan D, Nagano K, Baron R, Rosen CJ, Houseknecht KL. Propranolol Attenuates Risperidone-Induced Trabecular Bone Loss in Female Mice. Endocrinology 2015; 156:2374-83. [PMID: 25853667 PMCID: PMC4475716 DOI: 10.1210/en.2015-1099] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Atypical antipsychotic (AA) drugs cause significant metabolic side effects, and clinical data are emerging that demonstrate increased fracture risk and bone loss after treatment with the AA, risperidone (RIS). The pharmacology underlying the adverse effects on bone is unknown. However, RIS action in the central nervous system could be responsible because the sympathetic nervous system (SNS) is known to uncouple bone remodeling. RIS treatment in mice significantly lowered trabecular bone volume fraction (bone volume/total volume), owing to increased osteoclast-mediated erosion and reduced osteoblast-mediated bone formation. Daytime energy expenditure was also increased and was temporally associated with the plasma concentration of RIS. Even a single dose of RIS transiently elevated expression of brown adipose tissue markers of SNS activity and thermogenesis, Pgc1a and Ucp1. Rankl, an osteoclast recruitment factor regulated by the SNS, was also increased 1 hour after a single dose of RIS. Thus, we inferred that bone loss from RIS was regulated, at least in part, by the SNS. To test this, we administered RIS or vehicle to mice that were also receiving the nonselective β-blocker propranolol. Strikingly, RIS did not cause any changes in trabecular bone volume/total volume, erosion, or formation while propranolol was present. Furthermore, β2-adrenergic receptor null (Adrb2(-/-)) mice were also protected from RIS-induced bone loss. This is the first report to demonstrate SNS-mediated bone loss from any AA. Because AA medications are widely prescribed, especially to young adults, clinical studies are needed to assess whether β-blockers will prevent bone loss in this vulnerable population.
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Affiliation(s)
- Katherine J Motyl
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Victoria E DeMambro
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Deborah Barlow
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - David Olshan
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Kenichi Nagano
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Roland Baron
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Clifford J Rosen
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
| | - Karen L Houseknecht
- Center for Clinical and Translational Research (K.J.M., V.E.D., D.O., C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; Department of Pharmaceutical Sciences (D.B., K.L.H.), College of Pharmacy, University of New England, Portland, Maine 04005; and Department of Oral Medicine (K.N., R.B.), Infection and Immunity, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115
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Richter C, Berg A, Fleischer S, Köpke S, Balzer K, Fick EM, Sönnichsen A, Löscher S, Vollmar HC, Haastert B, Icks A, Dintsios CM, Mann E, Wolf U, Meyer G. Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): study protocol for a cluster-randomised controlled trial. Implement Sci 2015; 10:82. [PMID: 26037324 PMCID: PMC4464611 DOI: 10.1186/s13012-015-0268-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/15/2015] [Indexed: 12/02/2022] Open
Abstract
Background The majority of nursing home residents with dementia experience behavioural and psychological symptoms like apathy, agitation, and anxiety. According to analyses of prescription prevalence in Germany, antipsychotic drugs are regularly prescribed as first-line treatment of neuropsychiatric symptoms in persons with dementia, although guidelines clearly prioritise non-pharmacological interventions. Frequently, antipsychotic drugs are prescribed for inappropriate reasons and for too long without regular reviewing. The use of antipsychotics is associated with adverse events like increased risk of falling, stroke, and mortality. The aim of the study is to investigate whether a person-centred care approach, successfully evaluated in nursing homes in the United Kingdom, can be implemented in German nursing homes and, in comparison with a control group, can result in a clinically relevant reduction of the proportion of residents with antipsychotic prescriptions. Methods/design The study is a cluster-randomised controlled trial comparing an intervention group (two-day initial training on person-centred care and ongoing training and support programme) with a control group. Both study groups will receive, as optimised usual care, a medication review by an experienced psychiatrist/geriatrician providing feedback to the prescribing physician. Overall, 36 nursing homes in East, North, and West Germany will be randomised. The primary outcome is the proportion of residents receiving at least one antipsychotic prescription (long-term medication) after 12 months of follow-up. Secondary outcomes are residents’ quality of life, agitated behaviour, as well as safety parameters like falls and fall-related medical attention. A health economic evaluation and a process evaluation will be performed alongside the study. Discussion To improve care, a reduction of the current high prescription rate of antipsychotics in nursing homes by the intervention programme is expected. Trial registration ClinicalTrials.gov: NCT02295462 Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0268-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christin Richter
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Almuth Berg
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Steffen Fleischer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Sascha Köpke
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
| | - Katrin Balzer
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
| | - Eva-Maria Fick
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
| | - Andreas Sönnichsen
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Susanne Löscher
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany. .,Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | | | - Andrea Icks
- Department of Public Health, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - Charalabos-Markos Dintsios
- Department of Public Health, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - Eva Mann
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria.
| | - Ursula Wolf
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. .,University Hospital of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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Correll CU, Detraux J, De Lepeleire J, De Hert M. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry 2015; 14:119-36. [PMID: 26043321 PMCID: PMC4471960 DOI: 10.1002/wps.20204] [Citation(s) in RCA: 515] [Impact Index Per Article: 57.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
People with severe mental illness have a considerably shorter lifespan than the general population. This excess mortality is mainly due to physical illness. Next to mental illness-related factors, unhealthy lifestyle, and disparities in health care access and utilization, psychotropic medications can contribute to the risk of physical morbidity and mortality. We systematically reviewed the effects of antipsychotics, antidepressants and mood stabilizers on physical health outcomes in people with schizophrenia, depression and bipolar disorder. Updating and expanding our prior systematic review published in this journal, we searched MEDLINE (November 2009 - November 2014), combining the MeSH terms of major physical disease categories (and/or relevant diseases within these categories) with schizophrenia, major depressive disorder and bipolar disorder, and the three major psychotropic classes which received regulatory approval for these disorders, i.e., antipsychotics, antidepressants and mood stabilizers. We gave precedence to results from (systematic) reviews and meta-analyses wherever possible. Antipsychotics, and to a more restricted degree antidepressants and mood stabilizers, are associated with an increased risk for several physical diseases, including obesity, dyslipidemia, diabetes mellitus, thyroid disorders, hyponatremia; cardiovascular, respiratory tract, gastrointestinal, haematological, musculoskeletal and renal diseases, as well as movement and seizure disorders. Higher dosages, polypharmacy, and treatment of vulnerable (e.g., old or young) individuals are associated with greater absolute (elderly) and relative (youth) risk for most of these physical diseases. To what degree medication-specific and patient-specific risk factors interact, and how adverse outcomes can be minimized, allowing patients to derive maximum benefits from these medications, requires adequate clinical attention and further research.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, North Shore - Long Island Jewish Health SystemGlen Oaks, New York, NY, USA,Department of Psychiatry and Molecular Medicine, Hofstra North Shore LIJ School of MedicineHempstead, New York, NY, USA,Psychiatric Neuroscience Center of Excellence, Feinstein Institute for Medical ResearchManhasset, New York, NY, USA,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of MedicineBronx, New York, NY, USA
| | - Johan Detraux
- Department of Neurosciences, Catholic University LeuvenB-3070 Kortenberg, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, University of LeuvenB-3000 Leuven, Belgium
| | - Marc De Hert
- Department of Neurosciences, Catholic University LeuvenB-3070 Kortenberg, Belgium
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Jethwa KD, Onalaja OA. Antipsychotics for the management of psychosis in Parkinson's disease: systematic review and meta-analysis. BJPsych Open 2015; 1:27-33. [PMID: 27703720 PMCID: PMC4998940 DOI: 10.1192/bjpo.bp.115.000927] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/21/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Antipsychotics can exacerbate motor symptoms in Parkinson's disease psychosis. AIMS To systematically review the literature on the efficacy and acceptability of antipsychotics for Parkinson's disease psychosis. METHOD Randomised controlled trials comparing an antipsychotic with placebo were systematically reviewed. RESULTS The final selection list included nine studies using quetiapine (3), clozapine (2), olanzapine (3) and pimavanserin (1). A narrative synthesis and meta-analyses (where appropriate) were presented for each antipsychotic. Clozapine demonstrated superiority over placebo in reducing psychotic symptoms. Quetiapine and olanzapine did not significantly improve psychotic symptoms. All three antipsychotics may exacerbate motor symptoms. Quetiapine studies were associated with high drop-out rates due to adverse events. Pimavanserin is a novel treatment that warrants further investigation. CONCLUSIONS Further research is needed. Clozapine and pimavanserin appear to be a promising treatment for Parkinson's disease psychosis. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Ketan Dipak Jethwa
- Ketan Dipak Jethwa, BMBS, CT1 SHO in General Medicine, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Oluwademilade A. Onalaja
- Oluwademilade A. Onalaja, MRCPsych, Consultant Psychiatrist, Stratford Healthcare, Arden Street, Stratford-Upon-Avon, UK
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Alhmoud E, Khalifa S, Bahi AA. Prevalence and predictors of potentially inappropriate medications among home care elderly patients in Qatar. Int J Clin Pharm 2015; 37:815-21. [PMID: 25986290 DOI: 10.1007/s11096-015-0125-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 04/15/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Older patients receiving home health care are particularly at risk of receiving potentially inappropriate medications compared to community-dwelling population. Data on appropriateness of prescribing in these patients is limited. OBJECTIVE To investigate the prevalence, patterns and determinants of potentially inappropriate medications among elderly patients receiving Home Health Care Services in Qatar. SETTING Home Health Care Services department in Hamad Medical Corporation-Qatar. METHODS A cross-sectional study, conducted over a 3 months period. Patients 65 years and older, taking at least one medication and receiving home care services were included. Potentially inappropriate medications were identified and classified in accordance with the American Geriatrics Society 2012 Beers Criteria. MAIN OUTCOME MEASURE Prevalence of potentially inappropriate medications using updated Beers criteria. RESULTS A total of 191 patients (38.2%) had at least one potentially inappropriate medication. As per Beers criteria, 35% of medications were classified as medications to be avoided in older adults regardless of conditions and 9% as potentially inappropriate medications when used with certain diseases or syndromes. The majority of potentially inappropriate medications (56%) were classified as medications to be used with caution. The two leading classes of potentially inappropriate medications were antipsychotics (27.4%) and selective serotonin reuptake inhibitors (16%). Significant predictors of inappropriate prescribing were hypertension [adjusted OR 1.7; 95% CI (1.0, 2.8)], dementia [adjusted OR 2.0; 95% CI (1.2, 3.1)], depression [adjusted OR 21.6; 95% CI (2.8, 168.4)], and taking more than ten prescribed medications [adjusted OR 1.9; 95% CI (1.3, 2.8)]. CONCLUSION Prescribing potentially inappropriate medications is common among older adults receiving home health care services in Qatar, a finding that warrants further attention. Polypharmacy, hypertension, depression and dementia were significantly associated with potentially inappropriate prescribing.
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Affiliation(s)
- Eman Alhmoud
- Clinical Pharmacy Services-Pharmacy Department, Hamad General Hospital-Hamad Medical Corporation, Doha, Qatar.
| | - Sabah Khalifa
- Clinical Pharmacy Services-Pharmacy Department, Hamad General Hospital-Hamad Medical Corporation, Doha, Qatar
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