PSYCHOTROPIC MEDICATIONS USE AND HIP FRACTURE RISK IN COMMUNITY-DWELLING OLDER ADULTS: A NESTED KNOWLEDGE ASSISTED META-ANALYSIS
Author(s)
Prity Rani, PhD1, Joanita Lake, MSc EBHC1, Jason Young, MD2, Victoria Tiase, PhD2, Keith R. Kallmes, BS3, Carl V. Asche, PhD2.
1Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City, UT, USA, 2University of Utah, Salt Lake City, UT, USA, 3Nested Knowledge, St. Paul, MN, USA.
1Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City, UT, USA, 2University of Utah, Salt Lake City, UT, USA, 3Nested Knowledge, St. Paul, MN, USA.
OBJECTIVES: Falls are a leading cause of hip fractures among community-dwelling older adults, resulting in diminished quality of life and increased healthcare utilization. Psychotropic medication use in this population may increase fall risk through effects on cognition, balance, and sedation, yet the magnitude of their association with hip fracture risk remains poorly characterized. This review aims to quantify the association between the use of psychotropic medications and hip fracture risk among community-dwelling older adults.
METHODS: A systematic search of PubMed/Medline and Embase (1987-2025) was conducted. Inclusion criteria were observational studies examining the association of psychotropic use with hip fractures in community-dwelling older adults (≥65 years), using population-based cohort, case-control, case-crossover analyses, and cross-sectional analyses study designs. Nested Knowledge (NK) artificial intelligence (AI)-assisted automation supported screening, data extraction, and evidence synthesis. Study quality was assessed using Newcastle-Ottawa Scale (NOS), heterogeneity using the I2 statistic and pooled odds ratios (ORs) for the specific classes of psychotropic medications were estimated with random effects models.
RESULTS: The literature search identified 2,972 studies, of which 25 studies (>100,000 subjects) reported ORs for hip fracture risk in community-dwelling older adults. Hip fracture risk significantly increased with prescribed: antipsychotics (OR: 1.83, 95%CI:1.50-2.22, p<0.001), with higher risk for first-generation (OR: 1.64, 95%CI:1.39-1.94, p<0.001) compared to second-generation antipsychotics (OR: 1.37, 95%CI:1.24-1.54, p<0.0001); antidepressants (OR: 1.49, 95%CI:1.35-1.64, p<0.0001), selective serotonin reuptake inhibitor (OR: 1.68, 95%CI:1.33-2.13, p<0.0001) and tricyclic antidepressants (OR: 1.28, 95%CI:1.16-1.42, p<0.0001). Included studies were of moderate (n=23) to high (n=2) quality.
CONCLUSIONS: These findings highlight the need for cautious prescribing of psychotropic medications for community-dwelling older adults, particularly those at increased risk of falls or fractures, and emphasize the value of targeted fall prevention strategies. Additionally, the use of NK AI, with appropriate initial training, may facilitate faster screening and data extraction, thereby improving the efficiency of evidence synthesis.
METHODS: A systematic search of PubMed/Medline and Embase (1987-2025) was conducted. Inclusion criteria were observational studies examining the association of psychotropic use with hip fractures in community-dwelling older adults (≥65 years), using population-based cohort, case-control, case-crossover analyses, and cross-sectional analyses study designs. Nested Knowledge (NK) artificial intelligence (AI)-assisted automation supported screening, data extraction, and evidence synthesis. Study quality was assessed using Newcastle-Ottawa Scale (NOS), heterogeneity using the I2 statistic and pooled odds ratios (ORs) for the specific classes of psychotropic medications were estimated with random effects models.
RESULTS: The literature search identified 2,972 studies, of which 25 studies (>100,000 subjects) reported ORs for hip fracture risk in community-dwelling older adults. Hip fracture risk significantly increased with prescribed: antipsychotics (OR: 1.83, 95%CI:1.50-2.22, p<0.001), with higher risk for first-generation (OR: 1.64, 95%CI:1.39-1.94, p<0.001) compared to second-generation antipsychotics (OR: 1.37, 95%CI:1.24-1.54, p<0.0001); antidepressants (OR: 1.49, 95%CI:1.35-1.64, p<0.0001), selective serotonin reuptake inhibitor (OR: 1.68, 95%CI:1.33-2.13, p<0.0001) and tricyclic antidepressants (OR: 1.28, 95%CI:1.16-1.42, p<0.0001). Included studies were of moderate (n=23) to high (n=2) quality.
CONCLUSIONS: These findings highlight the need for cautious prescribing of psychotropic medications for community-dwelling older adults, particularly those at increased risk of falls or fractures, and emphasize the value of targeted fall prevention strategies. Additionally, the use of NK AI, with appropriate initial training, may facilitate faster screening and data extraction, thereby improving the efficiency of evidence synthesis.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH135
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health, Safety & Pharmacoepidemiology
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Geriatrics