ArticleBMJ open2019
Association between cumulative anticholinergic burden and falls and fractures in patients with overactive bladder: US-based retrospective cohort study.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 5 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
42 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Efficacy of Vibegron and Mirabegron for Overactive Bladder: A Systematic Literature Review and Indirect Treatment Comparison.Advances in therapy · 2021Pooled it
- Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review.European journal of clinical pharmacology · 2021Pooled it
- Increased risk of incident dementia following use of anticholinergic agents: A systematic literature review and meta-analysis.Neurourology and urodynamics · 2021Pooled it
- Decreasing patient-reported burden of treatment: A systematic review of quantitative interventional studies.PloS one · 2021Pooled it
- Comparative Safety and Efficacy of Treatments for Overactive Bladder Among Older Adults: A Network Meta-analysis.Drugs & aging · 2020Pooled it
- Trial
- Intravesical Instillation of OnabotulinumtoxinA in the Treatment of Refractory Overactive Bladder in Participants with Urinary Incontinence.The Journal of urology · 2022Trial
- Vibegron for the Treatment of Patients with Dry and Wet Overactive Bladder: A Subgroup Analysis from the EMPOWUR Trial.International journal of clinical practice · 2022Trial
- Multicomponent behavioral intervention to reduce exposure to anticholinergics in primary care older adults.Journal of the American Geriatrics Society · 2021Trial
- Trial
- Sex- and Age-Specific Trends in Prescriptions of Beta-3 Agonists and Anticholinergics in Japan: A Nationwide Prescription Database Study.Lower urinary tract symptoms · 2026Article
- Associations between Anticholinergic Burden and Skeletal Muscle Indices and Physical Function in Older Adults: A Scoping Review.JMA journal · 2026Review
- Treatment Persistence and Adherence with Overactive Bladder Medications in Taiwan: A Retrospective Database Analysis.European urology open science · 2026Article
- Association of Overactive Bladder With Fall Risk Among US Adults Aged 20-69 Years.Neurourology and urodynamics · 2026Article
- Health outcomes and costs in patients prescribed anticholinergic medications for overactive bladder.Journal of comparative effectiveness research · 2026Article
- Does Anticholinergic Burden Influence Therapeutic Success in Patients with Treatment-naïve Overactive Bladder?European urology open science · 2025Article
- Meclizine Use and Subsequent Falls Among Patients With Dizziness.JAMA otolaryngology-- head & neck surgery · 2025Article
- [Study of anticholinergic burden in chronic treatments of outpatients in the Community Pharmacy].Farmaceuticos comunitarios · 2025Observational
- Clinical Features and Current Pharmacotherapy of OAB in Practice: Ideal and Reality.Advances in therapy · 2025Article
- Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo estimate the association between cumulative anticholinergic burden and falls and fractures in patients with overactive bladder (OAB).
designA retrospective claims-based study (2007-2015) of patients with OAB; outcomes from a subset were contrasted to a non-OAB comparison.
settingUnited States, commercially and Medicare-insured population.
participants154 432 adults with OAB and 86 966 adults without OAB, mean age of 56 years, and 67.9% women.
main outcome measuresCumulative anticholinergic burden, a unitless value representing exposure over time, was estimated over the 12 months pre-index ('at baseline') and every 6 months post index. Burden was categorised as no burden (0), low burden (1-89), medium burden (90-499) or high burden (500+). Unadjusted rates of falls or fractures were estimated, and the increased risk associated with anticholinergic burden (measured at the closest 6-month interval prior to a fall or fracture) was assessed using a Cox proportional hazards model and a marginal structural model.
resultsMedian (IQR) baseline anticholinergic burden was 30 (0.0-314.0) and higher among older (≥65 years, 183 [3.0-713.0]) versus younger (<65 years, 13 [0.0-200.0]) adults. The unadjusted rate of falls or fractures over the period was 5.0 per 100 patient-years, ranging from 3.1 (95% CI 3.0-3.2) for those with no burden, to 7.4 (95% CI 7.1-7.6) for those with high burden at baseline. The adjusted risk of falls and fractures was greater with higher anticholinergic burden in the previous 6 months, with an HR of 1.2 (95% CI 1.2 to 1.3) for low burden versus no burden, to 1.4 (95% CI 1.3 to 1.4) for high versus no burden. Estimates from marginal structural models adjusting for time-varying covariates were lower but remained significantly higher with a higher anticholinergic burden. Rates of falls and fractures were approximately 40% higher among those with OAB (vs those without).
conclusionHigher levels of anticholinergic burden are associated with higher rates of falls and fractures, highlighting the importance of considering anticholinergic burden when treating patients with OAB.
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