Use of antipsychotics has been associated with an increased risk of fracture, although it is unclear if this risk is limited to older conventional antipsychotic medications or if newer atypical antipsychotics also carry this risk. Population-based data on 195,544 adults aged ≥65 who received a new outpatient prescription for an oral atypical antipsychotic (quetiapine, risperidone, or olanzapine) between June 1, 2003, and December 31, 2011 was matched 1 to 1 with controls who did not receive such a prescription and reviewed; the patients were followed for up to 90 days to assess fracture and fall outcomes.

New outpatient atypical antipsychotic medication use was associated with an increased 90-day risk of serious fall (52% increased risk) and nonvertebral osteoporotic fracture (50% increased risk). Similar increases were seen in hospital visits with falls and osteoporotic fractures. This risk was unaffected by the specific atypical antipsychotic medication used, dosage, and the living conditions of the individuals (eg, in a long-term care facility or in the community).

The authors add that confounding factors may predispose these patients to falls and fractures, such as behavioral disturbances that lead to the use of atypical antipsychotic medications. Particularly in the first 90 days of use, elderly patients taking antipsychotics should be assessed for fracture and fall risk with any additional appropriate steps taken to reduce this risk.