Neurology Central

Comparative risk of hip fractures in elderly nursing home patients with depression using paroxetine and other selective serotonin reuptake inhibitors

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Aim: To evaluate comparative safety of paroxetine and other selective serotonin reuptake inhibitors (SSRIs) for the risk of hip fractures. Patients & methods: A propensity score-matched retrospective cohort study was conducted using 2007–2010 Minimum Data Set linked Medicare data. Robust Cox proportional hazards model was used to evaluate the risk of hip fractures in depressed elderly nursing home residents. Results: Cox analysis did not find any significant difference in the risk of hip fractures for the paroxetine users (hazard ratio: 1.09; 95% CI: 0.91–1.32) when compared with other SSRIs. Results from the sensitivity analysis supported the main findings. Conclusion: There was no differential risk of hip fractures between paroxetine and other SSRIs. Future studies are needed to evaluate other anticholinergic effects of paroxetine.
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Falls and fractures among elderly people constitute a major public health concern with an estimated cost of US$19 billion [1]. Falls are the leading cause of accidental death and the seventh leading cause of death in persons more than 65 years of age [2]. More than 90% of hip fractures in elderly are caused by falls which can cause severe health problems including reduced quality of life and premature death [3]. Prevalence of hip fractures is estimated to be around 36–44% in nursing home residents [4,5]. Incidence of hip fractures is much higher in elderly nursing home residents than in community-dwelling elderly. Nursing home residents are at two-times higher risk of hip fractures than community-dwelling elderly patients [6–8]. Hip fractures are the major cause of hospitalization [9], morbidity, mortality and lack of ability to walk in nursing home patients [10,11,12].

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