Table 1.
Characteristics of cohort studies included in the present meta-analysis
| Study | Country | Sample size (AC drug user, (n)) |
Female (%) |
Age | Anatomical site of fracture | AC burden scale | Mean follow-up | Adjusted for confounders |
|---|---|---|---|---|---|---|---|---|
| Bali et al. (2016) [33] | USA |
9240 (4620) |
67 | ≥ 65 yr | hip | ARS, ACB, ADS* | 2.0 years |
age, sex, race, co-medications, and illness history during 1-year baseline period |
| Crispo et al. (2016) [34] | Canada |
16,302 (13,839) |
47 | ≥ 70 yr: 82.3% | any fracture | ARS |
3–6 days: 2463 persons 7–30 days: 5799 persons ≥31 days: 141 persons |
age, sex, race, length of stay, Elixhauser comorbidity score, census region, urban/rural status, hospital size (number of beds), and hospital teaching status |
| Hsu et al. (2017) [20] | Taiwan |
116,043 (43,301) |
50 | ≥ 65 yr | any fracture | ARS, ACB, DBI-Ach | 8.3 years | sex and time-varying comorbidities (annually measured by Carlson Comorbidity Index) |
| Ishida et al. (2019) [35] | USA |
60,007 (3745) |
56 | ≥ 65 yr | hip, femur, pelvis, foot, arm, hand, or axial skeleton | ACB** | 243 days****** |
age, sex, race, duration on dialysis, network, BMI, alcohol dependence, coronary artery disease, cancer, other cardiac disease, dysrhythmia, congestive heart failure, cerebrovascular disease, diabetes, drug dependence, opioid dependence, hypertension, inability to ambulate, inability to transfer, chronic obstructive pulmonary disease, peripheral vascular disease, tobacco dependence, dementia, depression, seizure/epilepsy liver disease, medication burden, and concomitant medications |
| Kao et al. (2018) [36] | Taiwan |
14,635 (2927) |
69 |
52.0 ± 16.9 yr (study cohort) 51.9 ± 17.1 yr (control) |
any fracture | ACB*** | 3.0 years | monthly income, geographical region, urbanization level, and comorbidities |
| Lu et al. (2015) [37] | Taiwan |
59,042 (7461) |
49 | ≥ 65 yr | any fracture | ARS | 7.95 ± 3.03 years | age, sex, and time-varying comorbidities |
| Moga et al. (2013) [39] | USA |
6594 (1125) |
4 | ≥ 65 yr |
hip or any fracture |
ARS, ACB, ADS**** |
AC drug users: 49 days (median) AC drug nonusers: 95 days (median) |
demographic characteristics, continence status (bladder and bowel), continence management, preexistent urinary tract infections, body mass index, comorbidities, other medication use, cognitive status, mobility at baseline |
| Sørensen et al. (2013) [40] | Denmark |
2224 (1216) |
not mention | 68.6 ± 12.8 yr | hip | ARS, ACB, ADS***** | not mention | age at diagnosis (schizophrenia), sex, alcohol misuse, somatic score |
AC: anticholinergic, ARS: anticholinergic risk scale, ACB: anticholinergic cognitive burden, ADS: anticholinergic drug scale
*AC drug used was paroxetine, which is 1 point on ARS, 3 points on ACB, and 1 point on ADS
** AC drugs used were amitriptyline, paroxetine, doxepin, nortriptyline, imipramine, desipramine and clomipramine, which are 3 points on ACB; and protriptyline which is not listed on ACB. Since less than 10 (0.01%) patients were taking protriptyline, we categorized all drugs use as ACB 3 points
*** AC drugs used were oxybutynin, trospium, tolterodine, solifenacin and propiverine, which are 3 points on ACB
**** AC drug used was oxybutynin, which is 3 points on ARS, ACB, and ADS
***** AC drugs used included risperidone, which is1 point on ARS and ACB; quetiapine which is 1 point on ARS and 3 points on ACB; olanzapine, which is 2 points on ARS, 3 points on ACB and 1 point on ADS; and aripiprazole, which is 1 point on ACB
******Follow-up period was calculated using fracture rate (6 events per 100 person-years) and number of fractures (4% of the cohort) described in the article