OBJECTIVES: Anticholinergics and sedatives are linked separately to initial and recurrent falls and fractures in older adults, specifically in those suffering from osteoporosis. This study examined biological, clinical, and social determinants of anticholinergic and sedative use in older women with osteoporosis.

METHODS: Cross-sectional analysis of nationally representative Medical Expenditure Panel Survey (2016 & 2018). Included (N=331) older women (age > 50 years) with osteoporosis (ICD-10 code-M80&M81) and were taking > 1 anticholinergic or sedative (multum therapeutic class codes). Multivariable survey logistic regressions were used to examine characteristics associated with prescription sedatives and/or anticholinergics.

RESULTS: 43.84% used at least 1 anticholinergic (5.74%) and/or sedative (38.1%), respectively. After adjusting for anxiety and depression, anticholinergics and sedative use were less likely among older [AOR 0.40,95%CI(0.21-0.75)], African American [AOR 0.44,95%CI(0.21-0.93)], and in the Midwest region [AOR 0.39,95%CI(0.19-0.80)], and more likely among those with extreme pain [AOR 4.36,95%CI(1.82-10.43)], lower income [AOR 1.95,95%CI(1.03-3.69)], and high school education [AOR 1.80,95%CI(0.99-3.26)] compared to younger women, whites, Northeast region, no pain, and high income.

CONCLUSIONS: Approximately 1 in 2 older women with osteoporosis were prescribed sedatives and/or anticholinergics. Our study highlighted the association of social determinants to sedative and/or anticholinergic use, which may be due to several factors including differences in health policies, clinical guidelines application and compliance, and access to care. Programs and interventions that promote health across health and non-health sectors are needed to reduce the use of “high-risk” prescription drugs among older women with osteoporosis. Future studies are needed to quantify the drug burden as well as negative consequences including quality of life of sedatives and/or anticholinergics in women who are already vulnerable to falls and fractures.