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Anticholinergic Medication Use and Fractures in Postmenopausal Women: Findings from the Women’s Health Initiative

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Abstract

Background

Anticholinergic medication use has been associated with several negative health outcomes in older adults, but little is known about its risk for fractures.

Objective

To examine the association between anticholinergic medication use and fracture outcomes in community-dwelling postmenopausal women.

Methods

Utilizing a prospective cohort design, we examined data collected from 137,408 women aged 50–79 years from the Women’s Health Initiative observational study and clinical trials not reporting hip fracture at baseline. Medications with moderate or strong anticholinergic effects were identified directly from drug containers during in-person interviews. The main outcome was fractures (hip, lower arm/wrist and total fractures). We performed multivariable Cox proportional hazard survival modelling to assess the association between anticholinergic use and the risk of fractures.

Results

At baseline, 10.6 % of the women were using an anticholinergic medication, of which antihistamines were the most common medication class (48.4 %). The multivariable-adjusted hazard ratios for anticholinergic medication use were 1.08 (95 % confidence interval [CI] 0.89–1.30) for hip fracture, 1.01 (95 % CI 0.91–1.13) for lower arm/wrist fracture and 1.03 (95 % CI 0.98–1.09) for total fractures. We observed no association according to subclass or count of anticholinergic medications, or trends between the duration of anticholinergic use and any of the fracture outcomes.

Conclusion

Anticholinergic medication use was not associated with an increased risk of fractures among community-dwelling women. Future research should make efforts to capture over-the-counter medication use and the cumulative anticholinergic burden in relation to important health outcomes for older adults.

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Acknowledgments

The authors thank the WHI investigators and staff for their dedication, and the study participants for making the programme possible. A full listing of WHI investigators can be found online at https://cleo.whi.org/researchers/Documents%20%20Write%20a%20Paper/WHI%20Investigator%20Short%20List.pdf.

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Authors and Affiliations

  1. School of Pharmacy, University of Washington, 1959 NE Pacific Street, H375G, Box 357630, Seattle, WA, 98195-7630, USA

    Zachary A. Marcum & Shelly L. Gray

  2. Amgen Inc., Thousand Oaks, CA, USA

    Heidi S. Wirtz

  3. WHI Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Mary Pettinger & Andrea Z. LaCroix

  4. Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA

    Ryan Carnahan

  5. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

    Jane A. Cauley

  6. University of Arizona Cancer Center, Tucson, AZ, USA

    Jennifer W. Bea

Authors
  1. Zachary A. Marcum
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  2. Heidi S. Wirtz
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  3. Mary Pettinger
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  4. Andrea Z. LaCroix
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  5. Ryan Carnahan
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  6. Jane A. Cauley
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  7. Jennifer W. Bea
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  8. Shelly L. Gray
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Corresponding author

Correspondence to Zachary A. Marcum.

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Funding

The WHI programme is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services, through contract nos. HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C and HHSN271201100004C.

Conflict of interest

Heidi Wirtz owns stock in Teva Pharmaceuticals. During the past 3 years, Andrea LaCroix served on the Scientific Methodology Advisory Panel for monitoring the safety of Prolia for Amgen. She also served on the Scientific Advisory Board for the Global Longitudinal Study of Osteoporosis in Women (GLOW), funded by Sanofi-Aventis and Proctor & Gamble (the Alliance for Better Bone Health) through an unrestricted research grant from the University of Massachusetts, Center for Outcomes Research. Zachary Marcum, Mary Pettinger, Ryan Carnahan, Jane Cauley, Jennifer Bea and Shelly Gray declare that they have no conflicts of interest, including financial interests, activities, relationships or affiliations, that are relevant to this study.

Ethical approval

All procedures performed in this study were approved by the respective institutional review boards at the participating institutions and were in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Marcum, Z.A., Wirtz, H.S., Pettinger, M. et al. Anticholinergic Medication Use and Fractures in Postmenopausal Women: Findings from the Women’s Health Initiative. Drugs Aging 32, 755–763 (2015). https://doi.org/10.1007/s40266-015-0298-1

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  • DOI: https://doi.org/10.1007/s40266-015-0298-1

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