精神科藥物與骨折、跌倒有關的證據越來越多


  【24drs.com】新研究認為,非典型抗精神病藥物可能與年長者骨折及跌倒風險增加有關。
  
  一篇包括近20萬名年長者的人口基礎世代研究顯示,相較於沒有使用抗精神病藥物者,處方有非典型抗精神病藥物的人,90天之後更可能發生非脊椎骨質疏鬆骨折、髖骨骨折、因為跌倒而就醫。
  
  此外,接受非典型抗精神病藥物者的嚴重跌倒風險增加52%,非脊椎骨質疏鬆骨折風險增加50%。
  
  有趣的是,非典型抗精神病藥物類型、劑量、個人生活狀況之間,並沒有顯著差異。
  
  加拿大安大略倫敦西安大略大學醫學系Lisa-Ann Fraser醫師等研究者寫道,非典型抗精神病藥物在以前被發現與高血壓、鎮靜、步態異常有關;因此,跌倒可能是這些藥物增加骨折風險的機轉。
  
  這篇研究線上發表於1月12日JAMA內科醫學期刊中的研究者通信。
  
  研究者評估了安大略省臨床評估科學資料庫的97,777名65歲以上年長者(平均81歲;64.6%是女性)的資料,這些人在2003年6月至2011年12月之間接受新的口服非典型抗精神病藥物處方;另外也包括97,777名年齡與性別配對但沒有使用非典型抗精神病藥物處方的成人。
  
  評估的非典型抗精神病藥物包括quetiapine(商品名Seroquel,AstraZeneca藥廠)、risperidone(商品名Risperdal,Janssen藥廠)以及olanzapine (多種品牌)。
  
  全部都追蹤90天,觀察有無跌倒或骨折;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%有類風濕性關節炎。
  
  此外,接受非典型抗精神病藥物組有10.7%曾經發生過骨折,沒有接受非典型抗精神病藥物組則是有10.2%;接受非典型抗精神病藥物組有12.2%曾經發生過跌倒,沒有接受非典型抗精神病藥物組則是9.3%。
  
  骨折類型分成:髖骨、非脊椎骨質疏鬆性、全部;全部包括頭顱、臉、手或腳所有預期發生骨折的部位。
  
  結果顯示,非典型抗精神病藥物組90天時的髖骨骨折風險(勝算比[OR],1.67; 95%信心區間[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)以及因跌倒就醫(OR,1.54;95% CI,1.47 - 1.61)都顯著增加。
  
  研究者寫道,次組分析發現,骨折和跌倒風險不受使用的藥物項目、劑量、居住在長照機構或社區等影響。
  
  整體而言,他們結論指出,這些研究結果對非典型抗精神病藥物的適應症之外使用提出質疑,支持增加它們用於年長者安全考量的證據。
  
  資料來源: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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