Anticholinergic burden and fractures: a protocol for a methodological systematic review and meta-analysis

Reinold, Jonas; Schäfer, Wiebke; Christianson, Lara; Barone-Adesi, Francesco; Riedel, Oliver; Pisa, Federica Edith

doi:10.1136/bmjopen-2019-030205

Cited by 3 publications

(5 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Evaluation of potentially eligible studies, data extraction as well as the risk of bias assessment were performed by two independent investigators. The review was performed according to the relevant guidelines [ 23 – 25 ] and the protocol was first registered in PROSPERO and subsequently published in an open access journal [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…This systematic review was conducted in accordance with the PRISMA [ 23 ] and MOOSE [ 24 ] guidelines as well as a guideline for the conduct of systematic reviews and meta-analyses in older adults [ 25 ]. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42018116737) and published in a peer-reviewed journal [ 26 ]. As the protocol has already been published, we will only give a brief description of methods.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Anticholinergic Burden and Fractures: A Systematic Review with Methodological Appraisal

et al. 2020

Self Cite

View full text Add to dashboard Cite

Introduction Medications with anticholinergic activity (MACs) are used to treat diseases common in older adults. Evidence on the association between anticholinergic burden (AB) and increased risk of fractures and osteoporosis or reduced bone mineral density (BMD) is inconsistent. Our aim was to conduct a systematic review of observational studies on AB with fractures and osteoporosis or reduced BMD and provide methodological appraisal of included studies. Methods We searched MEDLINE, EMBASE, Science Citation Index and CENTRAL as well as grey literature from database inception up to August 2020. Eligibility criteria were: observational design, AB-exposure measured through a scale, fracture of any type or osteoporosis or reduced BMD as outcome, and reported measure of association between exposure and outcome. No restrictions related to time, language or type of data were applied. Eligibility and risk of bias assessment as well as data extraction were performed independently by two reviewers. Risk of bias of the included studies was assessed using the Newcastle-Ottawa Scale and the RTI Item Bank. Results The majority of the nine included studies had low risk of bias but heterogeneous methodology. No study used a new user design. Seven studies reported an increased risk of fractures associated with AB. In four studies using the Anticholinergic Risk Scale (ARS), adjusted risk of fractures was increased by 2-61% for ARS = 1, by 0-97% for ARS = 2, by 19-84% for ARS = 3, and by 56-96% for ARS ≥ 4; in three studies the ARS was aggregated, risk increased by 39% for ARS = 1-2 and 17% for ARS = 2-3. Two studies reported increased risk of fractures of 14 and 52% in the highest AB-category and one study reported that change in ARS of ≥ 3 during hospitalization was associated with a 321% increased risk in fractures. Two studies did not find an association between AB and fractures. The association between AB and osteoporosis or reduced BMD could only be assessed in two studies, one reporting increased risk of lower BMD at Ward's triangle, the other reporting no association between AB and BMD T-score change at the femoral neck. Discussion Our study suggests an association between AB and increased risk of fractures with possible dose-exposure gradient in studies using the ARS. The low number of studies and heterogeneity of methods calls for the conduct of more studies. Plain language summary We conducted a study investigating the risk of fractures associated with anticholinergic burden, which is the result of taking one or more medication with anticholinergic activity. The results of our study suggest that persons who experience anticholinergic burden might have a higher risk of fractures. However, since we were only able to include nine studies, more studies conducted in a similar way are needed. Oliver Riedel and Federica Pisa share senior authorship. At the time of study conception and coordination, FEP worked at the Leibniz Institute for Prevention Research and Epidemiology-BIPS. From 1st March 2020 she is working at Bayer AG....

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Anticholinergic Burden and Fractures: A Systematic Review with Methodological Appraisal

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…14 Anticholinergic effects from antipsychotics and antihistamines are well documented as being associated with an increased risk for falls, fractures, and delirium. 24,25 Insulin use, particularly sliding scale insulin, has been documented as being associated with increased hospitalization and ED utilization. 19,26 Although NSAIDs are the most common long-term outpatient treatment used, they have been associated with potential risks in the short term in inpatient settings, including bleeding, acute kidney injury, and an increased risk for cardiac complications.…”

Section: Discussionmentioning

confidence: 99%

Adverse Outcomes Associated With Inpatient Administration of Beers List Medications Following Total Knee Replacement

Anderson

Liu

Cui

et al. 2020

Clinical Therapeutics

View full text Add to dashboard Cite

Purpose: Beers List drugs are potentially harmful in older adults and are grouped by level of risk. Over 9000 total knee arthroplasties (TKAs) are performed each year Veterans Affairs (VA) hospitals, primarily on older adults. Minimal data on the administration of Beers List drugs following arthroplasty currently exists in the literature. Our goal was to quantify the risks of these drugs following TKA. We hypothesized that increasing doses of Beers List drugs would be associated with increased risks for readmission, reoperation, emergency department (ED) visits, and mortality. Methods: In this retrospective cohort study, data from TKAs performed in VA hospitals from 2010 to 2014 were examined, with complicated or bilateral procedures excluded. The data were obtained from the VA Corporate Data Warehouse. The outcomes examined were readmission, postoperative ED visits, reoperation on ipsilateral knee, and mortality. Beers List drugs were divided into 3 categories: medications to use with caution (Beers 0); medications to avoid in older adults (Beers 1); and medications to avoid in certain disease states (Beers 2). Beers 2 was not included in the final analysis due to an inability to verify appropriate diagnostic criteria without manual chart review. Logistic regression was performed looking at the total number of doses in the first 48 h after surgery compared to the above-mentioned outcomes. Findings: Data from 12,639 TKAs were analyzed; the mean age of the patients was 65.06 years, and 77.8% of patients received Beers List drugs while admitted. The most frequently administered Beers

show abstract

“…The second identified assessment tool was less commonly employed in cancer-focused metaanalyses and systematic reviews [33,34]: the Research Triangle Institute (RTI) International and Item Bank on Risk of Bias and Precision of Observational Studies [35,36]. Although not commonly employed in cancer meta-analyses [33], it has been utilized in a variety of syntheses of other disease outcome association studies [36][37][38][39][40][41] and was employed in a systematic review of lung function in firefighters [42]. Of note, some investigators have employed both the NOQAS and the RTI item bank to assess quality in meta-analyses and systematic reviews [37,42,43].…”

Section: Study Quality Assessments In Observational Studiesmentioning

confidence: 99%

“…Although not commonly employed in cancer meta-analyses [33], it has been utilized in a variety of syntheses of other disease outcome association studies [36][37][38][39][40][41] and was employed in a systematic review of lung function in firefighters [42]. Of note, some investigators have employed both the NOQAS and the RTI item bank to assess quality in meta-analyses and systematic reviews [37,42,43]. The RTI item bank is comprised of 29 multiple-choice questions that is designed to assess a range of risk of bias and precision domains for a variety of observational study designs [36,37].…”

Section: Study Quality Assessments In Observational Studiesmentioning

confidence: 99%

An examination of psychometric properties of study quality assessment scales in meta-analysis: Rasch measurement model applied to the firefighter cancer literature

Ahn¹,

Pinheiro²,

McClure³

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

Most existing quality scales have been developed with minimal attention to accepted standards of psychometric properties. Even for those that have been used widely in medical research, limited evidence exists supporting their psychometric properties. The focus of our current study is to address this gap by evaluating the psychometrics properties of two existing quality scales that are frequently used in cancer observational research: (1) Item Bank on Risk of Bias and Precision of Observational Studies developed by the Research Triangle Institute (RTI) International and (2) Newcastle-Ottawa Quality Assessment Scale (NOQAS). We used the Rasch measurement model to evaluate the psychometric properties of two quality scales based on the ratings of 49 studies that examine firefighters’ cancer incidence and mortality. Our study found that RTI and NOQAS have an acceptable item reliability. Two raters were consistent in their assessment, demonstrating high interrater reliability. We also found that NOQAS has more items that show better fit than the RTI scale. The NOQAS produced lower study quality scores with a smaller variation, suggesting that NOQAS items are much easier to rate. Our findings accord with a previous study, which conclude that the RTI scale was harder to apply and thus produces more heterogenous quality scores than NOQAS. Although both RTI and NOQAS showed high item reliability, NOQAS items are better fit to the underlying construct, showing higher validity of internal structure and stronger psychometric properties. The current study adds to our understanding of the psychometric properties of NOQAS and RTI scales for future meta-analyses of observational studies, particularly in the firefighter cancer literature.

show abstract

Anticholinergic burden and fractures: a protocol for a methodological systematic review and meta-analysis

Cited by 3 publications

References 73 publications

Anticholinergic Burden and Fractures: A Systematic Review with Methodological Appraisal

Anticholinergic Burden and Fractures: A Systematic Review with Methodological Appraisal

Adverse Outcomes Associated With Inpatient Administration of Beers List Medications Following Total Knee Replacement

An examination of psychometric properties of study quality assessment scales in meta-analysis: Rasch measurement model applied to the firefighter cancer literature

Contact Info

Product

Resources

About