Comparative analysis of psychiatric medications and their association with falls and fractures: A systematic review and network meta-analysis

•This meta-analysis was to explore the relationship between psychiatric medications and the risk of falls and fractures in people taking them.•Typical antipsychotics, atypical antipsychotics and antidepressants are associated with the risk of falls.•Typical antipsychotics and atypical antipsychotics were associated with the risk of fractures.•Atypical antipsychotics and typical antipsychotics may be the drugs with the highest risk of falls and fractures, respectively.•Quetiapine and class z drugs may be the drugs with the highest risk of falls and fractures, respectively. An association between psychiatric medications and falls and fractures in people taking them has been demonstrated, but which class or medication leads to the greatest risk of falls or fractures should be further investigated. The aim of this study was to compare and rank the magnitude of risk of falls and fractures due to different psychiatric medications. Eight databases were searched for this meta-analysis and evaluated using a frequency-based network meta-analysis. The results included a total of 28 papers with 14 medications from 5 major classes, involving 3,467,314 patients. The results showed that atypical antipsychotics were the class of medications with the highest risk of falls, and typical antipsychotics were the class of medications with the highest risk of resulting in fractures. Quetiapine ranked first in the category of 13 medications associated with risk of falls, and class Z drugs ranked first in the category of 6 medications associated with risk of fractures. The available evidence suggests that atypical antipsychotics and typical antipsychotics may be the drugs with the highest risk of falls and fractures, respectively. Quetiapine may be the medication with the highest risk of falls, and class Z drugs may be the medication with the highest risk of fractures.