Acetylcholinesterase Inhibitors May Limit Fractures in Alzheimer Patients

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - In elderly patients with Alzheimer's disease (AD), use of acetylcholinesterase inhibitors is linked with reduced risk of osteoporotic fractures, new research from Spain suggests.

"This study has shown that acetylcholinesterase inhibitors, drugs commonly used in Alzheimer’s disease, have a protective effect against osteoporotic fractures in general. Moreover, this study confirms the strong link between the nervous system and bone physiology," lead author Dr. Iskandar Tamimi Marino, an orthopedic surgery consultant at Hospital Regional Universitario de Malaga, in Spain, told Reuters Health.

"These results could encourage clinicians to use these drugs routinely in Alzheimer’s patients, as they have a beneficial effect on both Alzheimer disease and the musculoskeletal system," he said in an email.

The researchers conducted a nested case-control study of data, from 1998 through 2013, on AD patients age 65 or older in two UK primary care databases: the Clinical Practice Research Datalink and the Hospital Episode Statistics database. At baseline, none had a history of osteoporotic fractures.

The 1,190 cases experienced a first diagnosis of osteoporotic fracture during the study period, at least one year after their AD diagnosis. The 4,760 controls - matched with cases by age, sex, duration of AD, and other pertinent factors - did not experience any osteoporotic fractures during the same period.

The findings were reported in Osteoporosis International, online December 20.

Compared to nonusers, patients with any use of acetylcholinesterase inhibitors (57% of the cohort) had a significantly lower risk of incident fracture (adjusted odds ratio, 0.80). The benefit was limited to acetylcholinesterase inhibitor users with at least 80% adherence (aOR, 0.76), representing roughly 84% of the patients with any acetylcholinesterase inhibitor use.

Principal investigator Dr. Faleh Tamimi Marino, assistant professor in the Faculty of Dentistry at McGill University in Montreal, Canada, told Reuters Health by email, "This study provides insight into the use of an already approved type of drug in a new type of application, and it demonstrates the clinical importance of the parasympathetic nervous system in aging conditions such as osteoporosis."

"Alzheimer patients at a risk of bone fractures should benefit from using AChEIs (acetylcholinesterase inhibitors) not only to improve their memory but also to improve their bones," he advised.

He cautioned, though, that "even though these drugs are beneficial for memory loss and bone metabolism, they may have other unforeseen negative side effects that could be affecting patient survival in a negative way."

Dr. Steven T. Harris, an endocrinologist and clinical professor of medicine at the University of California, San Francisco, said in a phone interview, "The take-home message is that if we have an Alzheimer's patient who is being treated with one of these acetylcholinesterase inhibitors, we can take solace in the fact that the drug isn't doing anything bad to bone and that it might actually be helping to reduce fracture risk."

"While this is an add-on to the profile of the medication and is not going to influence prescribing patterns or treatment patterns, this is an interesting speculation by the authors about another pathway involved in the control of bone, an interesting finding about the physiology of bone," noted Dr. Harris, who was not involved in the study.

SOURCE: https://bit.ly/2m7xheD

Osteoporos Int 2017.

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