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Anticholinergic burden and fractures: a protocol for a methodological systematic review and meta-analysis
  1. Jonas Reinold1,
  2. Wiebke Schäfer1,
  3. Lara Christianson1,
  4. Francesco Barone-Adesi2,
  5. Oliver Riedel1,
  6. Federica Edith Pisa1
  1. 1 Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
  2. 2 Department of Pharmaceutical Sciences, University of Eastern Piedmont, Novara, Italy
  1. Correspondence to Federica Edith Pisa; pisa{at}leibniz-bips.de

Abstract

Introduction Medications with anticholinergic activity are used in the treatment of many diseases common in old age, including depression, psychosis, Parkinson’s disease, allergies, pain and urinary incontinence. A high anticholinergic burden (ACB) is considered a major risk factor for fractures in older adults but recent studies reported inconsistent results. These inconsistencies may partly be due to differences in methodological aspects. However, no systematic review so far has addressed this association and considered study methods. Thus, we aim to conduct a systematic review and meta-analysis of observational studies addressing the association of ACB with fractures and to provide a methodological appraisal of the included studies.

Methods and analysis We will search MEDLINE, EMBASE, the Science Citation Index, CENTRAL and grey literature using a strategy that combines the terms anticholinergic and fractures. We will hand search reference lists of articles. Two reviewers will independently screen all identified abstracts for eligibility and evaluate the risk of bias of the included studies using the Newcastle-Ottawa Quality Assessment Scale and RTI item bank. Discrepancies will be resolved by consensus or consultation with a third researcher. We will conduct a meta-analysis, either for the overall population or for specific and more homogeneous subgroups, if the number of studies retrieved and their heterogeneity allows it.

Ethics and dissemination No ethics approval will be sought, as no original data will be collected for this review. Findings will be disseminated through peer-reviewed publication and conference presentations.

PROSPERO registration number CRD42018116737.

  • anticholinergic burden
  • anticholinergic agent
  • fractures

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors JR: study design, conduct of study, bibliographic research, design of data entry forms, data management, protocol and manuscript writing and review. WS: protocol and manuscript review. LC: bibliographic research design and conduct, protocol and manuscript review. FB-A: study design, protocol and manuscript review. OR: study conception and design, scientific coordination, protocol and manuscript review. FEP: study conception and design, scientific coordination, protocol and manuscript writing and review.

  • Funding This systematic review was funded entirely by internal funds of the Leibniz Institute for Prevention Research and Epidemiology: BIPS. The funding institution had no influence on any part of this protocol.

  • Competing interests None declared.

  • Patient and public involvement statement This systematic review protocol was done without patient involvement. Patients were not invited to comment on the study design or invited to contribute to the writing or editing of this document for readability or accuracy.

  • Patient consent for publication Not required.

  • Ethics approval No ethics approval will be sought, as no original data will be collected for this review. Findings will be disseminated through peer-reviewed publication and conference presentations.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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