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Sleeping pills double the risk for hip fracture

Patients who were middle-aged and taking benzodiazepines or nonbenzodiazepine hypnotics for 2 weeks or less were at increased risk for hip fracture, according to a systematic review and meta-analysis recently published in PLoS One.

“The [CDC] estimated that at least 300,000 older people are hospitalized in the U.S. per annum due to hip fracture ... The annual costs of hip fracture are approximately $10.3 billion to $15.2 billion in the U.S.,” Karen Donnelly, department of pharmacology, therapeutics and toxicology, Cardiff University School of Medicine in England, and colleagues wrote.

Donnelly and colleagues carried out a systematic review and meta-analysis of 18 studies found in MEDLINE and SCOPUS. The pooled relative risk for hip fracture was determined by utilizing a generic inverse variance method, with a random effects model, and using length of hypnotic usage as a subgroup. Exposure was categorized into two main subgroups: exposure to the benzodiazepines chlordiazepoxide, Onfi (clobazam, Lundbeck Pharmaceuticals), diazepam, lorazepam, nitrazepam, oprazolam, oxazepam, or temazepam vs. nonexposure; and exposure to the nonbenzodiazepine hypnotics zaleplon, zolpidem or zopiclone vs. nonexposure.

Length of usage was defined from the first prescription date, provided there was at least one hypnotic-free month. Short-term use was defined as use for up to 14 days, medium-term use was defined as use for 15 days to 30 days, long-term use was defined as use for longer than 1 month, and mixed use was a combination of medium- and long-term users. Participants in each of the studies were at least 50 years of age, and the mean age of participants was 65 or older.

Researchers found that taking benzodiazepines was significantly associated with an increased risk for hip fracture (RR = 1.52; 95% CI, 1.37-1.68), as was the use of nonbenzodiazepine hypnotics (RR = 1.71; 95% CI, 1.45-2.01). Short-term use of benzodiazepines (RR = 2.4; 95% CI, 1.88-3.05) and nonbenzodiazepine hypnotics (RR = 2.39; 95% CI, 1.74-3.29) was associated with the highest risk for hip fracture.

“Careful consideration of the immediate increased risk of hip fracture should inform the clinical decision-making process,” Ben Carter, PhD, MSc, BSc, Institute of Primary Care and Public Health, Cardiff University School of Medicine in England, said in a press release. “Clinically effective measures like strength training to improve frailty, removal of hazards at home, visual correction and a medication review are also needed to mitigate the risk of hip fractures, particularly in the first few days of use.” – by Janel Miller

Disclosure: Healio Family Medicine was unable to determine the researchers’ relevant financial disclosures prior to publication.