Table 3

Studies on the risk of hip/femur fracture associated with antipsychotic medicines
Study Population Outcome Propensity for bias/Study quality Procedures to minimize bias Follow-up Outcome Rate in reference group Result
LEVEL III Evidence: Observational Studies
Studies that compared atypical antipsychotic (ATYP) treatment to non-use (NU)
COHORT STUDIES
Normand [46] 1286395 All patients (Canada) (age>65) Hip fracture Moderate/Low Yes (covariate adjustment) NR NR OR (ATYP v NU); 2.2 95% CI; 2.1-2.4
CASE-CONTROL STUDIES
Liperoti [47] 1787 cases, 5606 controls Institutionalised patients (US) (age>=65) Hospitalisation for hip fracture ICD9 820-821 Moderate/Moderate Yes (matched on; admitted to same facility for septicemia, GI, MI) NR NA OR (ATYP v NU); 1.37 95% CI; 1.11-1.69 OR (RISP v NU); 1.42 95% CI; 1.12-1.80 OR (OLA v NU); 1.34 95% CI; 0.87-2.07 OR (OTHERATYP v NU); 1.03 95% CI; 0.47-2.28
Kolanowski [35] 959 Dementia patients, health care insured on Southeast US (age>70) Diagnosis of hip Fracture Moderate/Low Yes (unmatched covariate adjustment) 45 days NA OR (ATYP v NU); 1.47 95% CI; 0.82-2.65
Pouwels [48] 6763 cases, 26341 controls All patients, PHARMO Database (Netherlands) (age>18) Hospitalis-ation for Hip fracture Moderate/Low Yes (Matched on; year of birth, sex, geographic region) 12 years NA OR (ATYP v NU); 0.83 95% CI; 0.42-1.65
Jalbert [49] 764 cases, 3582 controls Long stay Medicaid-eligible resident living in nursing homes with at least 20 beds (age>65) Hospitalis-ation for Hip fracture ICD9 820 Moderate/Low Yes (Matched; admitted to same facility, covariate adjustment) 2 years NA New use: OR (ATYP v NU); 1.36 95% CI; 0.95-1.94 Prevalent use: OR (ATYP v NU); 1.33 95% CI; 1.08-1.63
SELF-CONTROLLED CASE SERIES STUDIES
Pratt [50] 8285, Australian Department of Veterans Affairs Veterans/spouses with hospitalization for hip fracture (Australia) (age>=65) Hospitalis-ation for Hip fracture ICD10 S720, S721 Moderate/Moderate Yes (within patient design) 4 years NA 1 week: IRR (ATYP V UEXP); 2.17 95% CI; 1.54-3.06 2-8 weeks: IRR (ATYP V UEXP); 1.27 95% CI; 1.04-1.55 9-12 weeks: IRR (ATYP V UEXP); 1.23 95% CI; 0.92-1.63 >12 weeks: IRR (ATYP V UEXP); 1.43 95% CI; 1.23-1.66
Studies that compared conventional antipsychotic (CONV) treatment to non-use (NU)
CASE-CONTROL STUDIES
Liperoti [47] 1787 cases, 5606 controls Institutionalised patients (US) (age>=65) Hospitalis-ation for hip fracture Moderate Yes (covariate adjustment and matched; on admitted to same facility for septicemia,GI,MI) NR NA OR (CONV v NU); 1.35 95% CI; 1.06-1.71 OR (HALO v NU); 1.53 95% CI; 1.18-2.26 OR (OTHERCONV v NU); 1.09 95% CI; 0.78-1.52
Kolanowski [35] 959 Dementia patients, health care insured on Southeast US (age>70) Diagnosis of hip Fracture Moderate Yes (covariate adjustment) 45 days NA OR (CONV v NU); 2.33 95% CI; 1.08-5.03
Pouwels [48] 6763 cases, 26341 controls All patients, PHARMO Database (Netherlands) (age>18) Hospitalis-ation for Hip fracture Moderate Yes (Matched; year of birth, sex, geographic region) 12 years NA OR (CONV v NU); 1.76 95% CI; 1.48-2.08
Jalbert [49] 764 cases, 3582 controls Long stay Medicaid-eligible resident living in nursing homes with at least 20 beds (age>65) Hospitalis-ation for Hip fracture Moderate Yes (Matched; admitted to same facility) 2 years NA Prevalent use: OR (CONV v NU); 1.28 95% CI; 0.7-2.34
SELF-CONTROLLED CASE SERIES STUDIES
Pratt et al. [50] 8285, Australian Department of Veterans Affairs Veterans/spouses with hospitalization for hip fracture (Australia) (age>=65) Hospitalis-ation for Hip fracture ICD10 S720, S721 Moderate Yes (within patient design) 4 years NA 1 week: IRR (CONV V UEXP); 1.04 95% CI; 0.40-2.70 2-8 weeks: IRR (CONV V UEXP); 2.23 95% CI; 1.65-3.02 9-12 weeks: IRR (CONV V UEXP); 1.79 95% CI; 1.12-2.84 >12 weeks: IRR (CONV V UEXP); 2.19 95% CI; 1.62-2.95
Studies that compared all antipsychotics with non-use (NU)
CASE-CONTROL STUDIES
Wang [51] 1222 cases, 4888 controls Elderly patients enrolled in Medicare as well as in the New Jersey Medicaid or Pharmaceutical Assistance to the Aged and Disabled programs (age>=65) Hospitalis-ation for hip fracture Moderate/Moderate Yes (matched on; year birth and gender, covariate adjustment) NR NA OR (ATYP v NU); 1.60 95% CI NR
Studies that compared conventional antipsychotic (CONV) and atypical antipsychotic (ATYP) treatment
COHORT STUDIES
Normand [46] 1286395 All patients, in Ontario (Canada) (age>65) Hip fracture Moderate/Low Yes (covariate adjustment) NR NR OR (ATYP v CONV); 0.5 95% CI; 0.4-0.5

Pratt et al.

Pratt et al. BMC Medical Research Methodology 2012 12:72   doi:10.1186/1471-2288-12-72

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