Anticholinergic use is associated with lower mortality but not increased hip fracture risk in Parkinson’s disease patients: a retrospective cohort study

Background: It is unclear whether antiparkinsonism anticholinergics (AAs) increase hip fracture (HFx) risk in Parkinson’s disease (PD) patients. This study examined associations between AAs, HFx and mortality in PD using Taiwan’s National Health Insurance Database. Methods: Newly diagnosed PD patients ≥ 50yrs were categorized by AAs exposure: PD with AAs (≥ 90 days, n = 16,921), PD without AAs (never-exposed, n = 55,940), and demographically matched non-PD controls (n = 291,444). Competing risk of death was considered in Fine & Gray models analyzing HFx. Mortality was compared using Cox regression models. Results: Both PD groups were associated with higher HFx risk compared to non-PD controls (adjusted hazard ratio [HR] = 1.51 for PD with AAs; 1.53 without). No significant difference in HFx risk was observed between PD groups with and without AAs exposure. Both groups were associated with increased mortality compared to non-PD (adjusted HR = 2.24 with AAs; 2.44 without AAs). Among PD patients, those with AAs exposure were associated with lower mortality compared to those without AAs (adjusted HR = 0.93). Conclusions: PD was associated with increased HFx and mortality compared to non-PD, regardless of AAs exposure. AAs use was not associated with increased HFx risk and was associated with lower mortality. AAs use was not associated with increased fracture risk and was associated with lower mortality in PD, however further studies are needed to clarify these associations.