精神科药物与骨折、跌倒有关的证据越来越多


  【24drs.com】新研究认为,非典型抗精神病药物可能与年长者骨折及跌倒风险增加有关。
  
  一篇包括近20万名年长者的人口基础世代研究显示,相较于没有使用抗精神病药物者,处方有非典型抗精神病药物的人,90天之后更可能发生非脊椎骨质疏松骨折、髋骨骨折、因为跌倒而就医。
  
  此外,接受非典型抗精神病药物者的严重跌倒风险增加52%,非脊椎骨质疏松骨折风险增加50%。
  
  有趣的是,非典型抗精神病药物类型、剂量、个人生活状况之间,并没有显著差异。
  
  加拿大安大略伦敦西安大略大学医学系Lisa-Ann Fraser医师等研究者写道,非典型抗精神病药物在以前被发现与高血压、镇静、步态异常有关;因此,跌倒可能是这些药物增加骨折风险的机转。
  
  这篇研究在线发表于1月12日JAMA内科医学期刊中的研究者通信。
  
  研究者评估了安大略省临床评估科学资料库的97,777名65岁以上年长者(平均81岁;64.6%是女性)的资料,这些人在2003年6月至2011年12月之间接受新的口服非典型抗精神病药物处方;另外也包括97,777名年龄与性别配对但没有使用非典型抗精神病药物处方的成人。
  
  评估的非典型抗精神病药物包括quetiapine(商品名Seroquel,AstraZeneca药厂)、risperidone(商品名Risperdal,Janssen药厂)以及olanzapine (多种品牌)。
  
  全部都追踪90天,观察有无跌倒或骨折;共有53.9%的人有失智,7.6%有精神科疾病,至少16.5%有糖尿病,0.3%有类风湿性关节炎。
  
  此外,接受非典型抗精神病药物组有10.7%曾经发生过骨折,没有接受非典型抗精神病药物组则是有10.2%;接受非典型抗精神病药物组有12.2%曾经发生过跌倒,没有接受非典型抗精神病药物组则是9.3%。
  
  骨折类型分成:髋骨、非脊椎骨质疏松性、全部;全部包括头颅、脸、手或脚所有预期发生骨折的部位。
  
  结果显示,非典型抗精神病药物组90天时的髋骨骨折风险(胜算比[OR],1.67; 95%信心区间[CI],1.53 - 1.81),非脊椎骨折(OR,1.51;95% CI,1.41 - 1.60)、全部骨折(OR,1.29;95% CI,1.24 - 1.34)以及因跌倒就医(OR,1.54;95% CI,1.47 - 1.61)都显著增加。
  
  研究者写道,次组分析发现,骨折和跌倒风险不受使用的药物项目、剂量、居住在长照机构或社区等影响。
  
  整体而言,他们结论指出,这些研究结果对非典型抗精神病药物的适应症之外使用提出质疑,支持增加它们用于年长者安全考量的证据。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7151&x_classno=0&x_chkdelpoint=Y
  

More Evidence Antipsychotics Linked to Fractures, Falls

By Deborah Brauser
Medscape Medical News

Atypical antipsychotic medications may be linked to an increased risk for fractures and falls in the elderly, new research suggests.

A population-based cohort study of almost 200,000 older adults showed that those who were prescribed an atypical antipsychotic were more likely 90 days later to have nonvertebral osteoporotic fractures, hip fractures, and hospital visits due to a fall than their peers who did not receive this type of prescription.

In addition, the group receiving atypical antipsychotics had a 52% increased risk for a serious fall and a 50% increased risk for a nonvertebral osteoporotic fracture.

Interestingly, there were no significant differences between type of atypical antipsychotic, dosage, or individual living situation.

"Atypical antipsychotic medications have been found previously to be associated with hypotension, sedation, and gait abnormalities," write the investigators, led by Lisa-Ann Fraser, MD, from the Department of Medicine at the University of Western Ontario, London, Ontario, Canada.

"Therefore, it is possible that falls are the mechanism by which these drugs increase fracture risk," they add.

The study was published online January 12 in a JAMA Internal Medicine research letter.

Wisdom of Widespread Use Questioned

The investigators evaluated linked databases from the Clinical Evaluative Sciences in Ontario for 97,777 adults aged 65 years and older (mean age, 81 years; 64.6% women) who received a new prescription for an oral atypical antipsychotic between June 2003 and December 2011. A total of 97,777 age- and sex-matched adults without antipsychotic prescriptions were also included.

Atypicals evaluated included quetiapine (Seroquel, AstraZeneca Pharmaceuticals LP), risperidone (Risperdal, Janssen Pharmaceuticals, Inc) and olanzapine (multiple brands).

The entire group was followed for 90 days to watch for fractures and falls. A total of 53.9% of each group had dementia, 7.6% of each had a psychotic disorder, at least 16.5% had diabetes, and 0.3% had rheumatoid arthritis.

Also, 10.7% of the group receiving antipsychotics had had a previous fracture, compared with 10.2% of the group not receiving antipsychotics; 12.2% of the group receiving antipsychotics had had a previous fall, compared with 9.3% of those not receiving an antipsychotic.

Fracture type was grouped into the following categories: hip, nonvertebral osteoporotic, and "all." The latter included all fractures except those involving the skull, face, hands, or feet.

Results showed that the atypical antipsychotics group had a significantly increased 90-day risk for hip fracture (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.53 - 1.81), nonvetebral fracture (OR, 1.51; 95% CI, 1.41 - 1.60), all fractures (OR, 1.29; 95% CI, 1.24 - 1.34), and hospital visits due to a fall (OR, 1.54; 95% CI, 1.47 - 1.61).

"Sub-group analyses found that the risk of fracture and falling was unaffected by the specific atypical antipsychotic used, high vs low dosage, or whether the individual lived in a long-term care facility or in the community," write the investigators.

Overall, "these findings call into question the widespread off-label use of atypical antipsychotic medications and support increasing evidence of safety concerns regarding their use in older adults," they conclude.

Dr Fraser and five of the other study authors have reported no relevant financial relationships. The remaining study author reports having received investigator-initiated grants from Astellas and Roche and that his institution received unrestricted funding from Pfizer.

JAMA Intern Med. Published online January 12, 2015.

    
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