Acetylcholinesterase inhibitors and the risk of hip fracture in Alzheimer’s disease patients: a case-control study
Previous studies have recently highlighted the role of acetylcholine in the regulation of bone remodeling. The acetylcholine receptor is reported to be present in bone-forming osteoblastic lineage, and its inhibition has negative effects on bone mass and fracture-healing capacity. Acetylcholine level within bone tissue is tightly regulated by the production of acetylcholinesterase which degrades acetylcholine. Acetylcholinesterase inhibitors are used as treatment for Alzheimer’s disease (AD) patients. This case control study  intended to evaluate whether the use of acetylcholinesterase inhibitors is associated with a decrease of hip fracture risk in AD patients aged over 75 years old.
Incidence of hip fracture risk has been measured among a group of 2258 AD patients. 80 of them suffered hip fracture during follow-up and 2178 did not. Compared with patients treated by other molecules, patients treated with acetylcholinesterase inhibitors had a risk of hip fracture reduced by more than twofold (odds ratio 0,42) when data were adjusted for body mass index, fall risk, smoking habits, cognition, age, gender, and dependence comorbidity score. The hip fracture risk odd ratio was even smaller for patients treated with rivastigmine (0,22) and doneprezil (0,39) compared with patients who followed acetylcholinesterase inhibitor-free treatment.
These data suggest that elderly patients that are at risk of developing osteoporosis and pathological fractures may potentially benefit from treatment with acetylcholinesterase inhibitors.
- Tamini I et al. J Bone Miner Res. 2012; 27:1518-1527.