Oral Presentation 33rd ASM of the Australian & New Zealand Bone & Mineral Society 2023

Acetylcholinesterase inhibitors reduce fracture and mortality risk in older patients with dementia syndromes (#5)

Charles Inderjeeth 1 , Emma Boland 2 , Maxine Isbel 2 , Diren-Che Inderjeeth 2
  1. North Metropolitan Health and University of Western Australia, Nedlands, WA, Australia
  2. Sir Charles Gairdner Hospital, Perth, WA, Australia

Background: Older people are at high risk of osteoporosis and dementia. We reported that in vitro and in vivo mouse models suggest that antidementia medications acetylcholinesterase inhibitors improve bone health through its impact on inhibiting osteoclasts and a potential anabolic effect on osteoblasts (Ref1). In this study we a looked at the impact of acetylcholinesterase in fracture risk and mortality in patients with dementia syndromes.

 

Methods: In this aged care, dementia clinic, cohort study we follow-up 744 patients annually for 4 years. The main outcomes assessed were, incidence of new fracture and death. Data was entered into SPSS with analysis of frequency and comparison of groups using Chi-Square Test. Main analysis was demographics and risk factors at baseline, diagnosis of dementia, prevalence of baseline osteoporosis and fracture, falls risk, dementia medications, osteoporosis medications and follow up incidence of fracture and mortality.

 

Results: There were 744 patients followed up. At baseline fifty-nine percent were female and mean age was 81 years (SD6.8). Twenty one percent had prior hip fracture Fifty six percent had dementia and 113 (15.2%) were on dementia medications at baseline. During 4 years of annual follow up 137(18%) reported new fractures (some multiple and hip). Overall mortality rate was 267/744 (36%). Patients with dementia were more likely to die (180/415 vs 87/329; p <0.001) with a trend to more fractures (73/415 vs 64/329; p = 0.078). Patients on dementia medications were less likely to fracture 15/113 vs 122/631 (p = 0.029).

64ba3764d4abe-AChEI+and+Fracture+Picture2.jpg

Conclusions: Patients with dementia have a higher risk of recurrent fractures and mortality. Treating dementia with acetylcholinesterase inhibitors appear to reduce the risk of all fractures. This clinical finding is consistent with our recently published in vitro and in vivo mouse model confirming the benefit of cholinesterase inhibitors on bone biology, histology and biomarkers.

  1. Shangfu Li, Dian Teguh, Depeng Wu, Lesong Liu, Chaofeng Hu, Jinbo Yuan, Inderjeeth Charles and Jiake Xu. Anti-dementia medication acetylcholinesterase inhibitors may have therapeutic benefits on osteoporotic bone by attenuating osteoclastogenesis and bone resorption. Journal of Cellular Physiology. 19 May 2023 http://doi.org/10.1002/jcp.31057