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Acetylcholinesterase inhibitors and the risk of osteoporotic fractures: nested case-control study

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Abstract

Summary

The objective of this study was to analyze the effect of acetylcholinesterase inhibitors (AChEIs) on the risk of osteoporotic fractures in Alzheimer patients. A nested case-control study was conducted on 1190 cases and 4760 controls. The use of AChEIs was found to decrease the risk of osteoporotic fractures in these patients.

Introduction

The objective of this study is to estimate the extent to which the use of AChEIs is associated with a reduction in the risk of osteoporotic fractures.

Methods

A nested case-control study was conducted using data from the UK Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) database (1998–2013). The study cohort consisted of Alzheimer’s Disease (AD) patients aged ≥ 65 years with no previous history of osteoporotic fractures at cohort baseline. Cases were individuals who suffered an osteoporotic fracture during the study period, whereas controls were subject who did not experience any osteoporotic fractures during the same period. Controls were drawn from the population time at risk while being matched to the cases in respect to age, sex, up-to-standard follow-up in the CPRD, calendar time, and duration of AD (control-to-case ratio: 4-to-1). Information on the use of AChEIs and the relevant potential confounders was ascertained from the CPRD database for all the cases and controls.

Results

We identified 1190 cases and 4760 controls. Compared to non-users, any use of AChEIs prior to the fracture was associated with a reduction in the fracture risk [adjusted odds ratio (OR) 0.80 (confidence interval (CI) 95%, 0.70–0.91)]. The use of AChEIs corresponding to a proportion of days covered of 0.8–1.0 was associated with a lower osteoporotic fracture risk compared to non-use [adjusted OR 0.76 (CI 95%, 0.66–0.87)].

Conclusions

In this study using large primary care databases, the use and treatment adherence to AChEIs were associated with a decreased risk of osteoporotic fractures in elderly AD patients.

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Change history

  • 15 April 2019

    Please find below the correction for the paragraph under the Heading ���Materials and methods ��� Regulatory approval���.

  • 15 April 2019

    Please find below the correction for the paragraph under the Heading ���Materials and methods ��� Regulatory approval���.

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Acknowledgments

We would like to thank the Canadian Institute of Health Research for their financial support. We would also like to thank the patients that participated in this study for their collaboration.

Funding

This study was funded by the Canadian Institute of Health Research [MOP-13056x0].

Author information

Authors and Affiliations

  1. Hospital Regional Universitario de Malaga, Avenida Carlos Haya SN, 29010, Malaga, Spain

    I. Tamimi

  2. Division of Oral Health and Society Research, Faculty of Dentistry, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1G1, Canada

    B. Nicolau

  3. Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre 8440 112 St. NW, Edmonton, Alberta, T6G 2R7, Canada

    H. Eimar

  4. Division of Oral Health and Society Research, Faculty of Dentistry, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1G1, Canada

    S. Arekunnath Madathil

  5. Department of Epidemiology and Biostatistics, Centre for Clinical Epidemiology, Lady Davis Institute, 3755 Cote-Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada

    A. Kezouh

  6. Department of Epidemiology and Biostatistics, Kresge Building K214, Western University, London, Ontario, N6A 5C1, Canada

    I. Karp

  7. Faculty of Dentistry, McGill University, 3640 University Street, Montreal, QC, H3A 2B2, Canada

    F. Tamimi

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Dr. Tamimi affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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Tamimi, I., Nicolau, B., Eimar, H. et al. Acetylcholinesterase inhibitors and the risk of osteoporotic fractures: nested case-control study. Osteoporos Int 29, 849–857 (2018). https://doi.org/10.1007/s00198-017-4346-z

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