{"doi":"10.17615/geqs-gg12","title":"Effects of anticholinergic and sedative medication use on fractures: A self-controlled design study","abstract":"Background/Objectives: Unintentional falls are a leading cause of injury for older adults, and evidence is needed to understand modifiable risk factors. We evaluated 1-year fall-related fracture risk and whether dispensing of medications with anticholinergic/sedating properties is temporally associated with an increased odds of these fractures. Design: A retrospective cohort study with nested self-controlled analyses conducted between January 1, 2014, and December 31, 2016. Setting: Twenty percent nationwide, random sample of US Medicare beneficiaries. Participants: New users of medications with anticholinergic/sedating properties who were 66+ years old and had Medicare Parts A, B, and D coverage but no claims for medications with anticholinergic/sedating properties in the year before initiation were eligible. Measurements: We followed new users of medications with anticholinergic/sedating properties until first non-vertebral, fall-related fracture (primary outcome), Medicare disenrollment, death, or end of study data. We estimated the 1-year risk with corresponding 95% confidence intervals (CIs) of first fracture after new use. We applied the self-controlled case-crossover and case-time-control designs to estimate odds ratios (ORs) and 95% CIs by comparing anticholinergic and/or sedating medication exposure (any vs. none) during a 14-day hazard period preceding the fracture to exposure to these medications during an earlier 14-day control period. Results: A total of 1,097,989 Medicare beneficiaries initiated medications with anticholinergic/sedating properties in the study period. The 1-year cumulative incidence of fall-related fracture, accounting for death as a competing risk, was 5.0% (95% CI: 5.0%–5.0%). Using the case-crossover design (n = 41,889), the adjusted OR for the association between anticholinergic/sedating medications and fractures was 1.03 (95% CI: 0.99, 1.08). Accounting for the noted temporal trend using the case-time-control design (n = 209,395), the adjusted OR was 1.60 (95% CI: 1.52, 1.69). Conclusion: Use of anticholinergic/sedating medication was temporally associated with an increased odds of fall-related fractures. Patients and their healthcare providers should consider pharmacologic and non-pharmacologic treatments for the target condition that are safer.","journal":"UNC Libraries","year":2023,"id":387652,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9605,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":396956,"name":"Laura C. Hanson","orcid":"0000-0001-5120-6058","position":1,"is_corresponding":false},{"id":921619,"name":"Jennifer Bailey","orcid":"0000-0002-7052-4112","position":2,"is_corresponding":false},{"id":427888,"name":"Danijela Gnjidic","orcid":"0000-0002-9404-3401","position":3,"is_corresponding":false},{"id":427887,"name":"Rebecca B. Naumann","orcid":"0000-0002-6648-0794","position":4,"is_corresponding":false},{"id":383773,"name":"Yvonne M. Golightly","orcid":"0000-0003-1205-2759","position":5,"is_corresponding":false},{"id":427885,"name":"Marc J. Pepin","orcid":"0000-0002-7560-4461","position":6,"is_corresponding":false},{"id":426826,"name":"Virginia Pate","orcid":"0000-0002-2141-8882","position":7,"is_corresponding":false},{"id":387620,"name":"Jennifer L. Lund","orcid":"0000-0002-1108-0689","position":8,"is_corresponding":false},{"id":427884,"name":"Shahar Shmuel","orcid":"0000-0003-1726-1875","position":9,"is_corresponding":false},{"id":426828,"name":"Til Stürmer‎","orcid":"0000-0002-9204-7177","position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-19T01:18:08.845494Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}