‘Z-drugs’ may increase fracture risk in older adults

Chris Fox

Non-benzodiazepine hypnotic “Z-drugs,” such as zolpidem, zopiclone and zaleplon, which are often prescribed to help treat insomnia in older adults, were linked to a 40% greater risk for fracture in this population, according to data presented at the 2018 Alzheimer's Association International Conference.

“These medicines are in common use — in the U.S., for example, zolpidem is the most frequently prescribed hypnotic and fourth most commonly prescribed psychiatric drug,” Chris Fox, MD, professor of psychiatry at Norwich Medical School University of East Anglia in the U.K., told Healio Psychiatry. “With the recent problems with antipsychotics, which has led to them being avoided, there has been an escalation of use of Z-medicines and benzodiazepines in people with dementia. We undertook this study to answer the apparent myth that Z-medicines are safe.”

To examine whether Z-drugs are particularly harmful for people with dementia, Fox and colleagues analyzed existing data from the U.K. Clinical Practice Research Datalink and from three clinical studies of people with dementia. The datalink analysis included 6,922 individuals with dementia with sleep disturbance and 3,102 prescribed Z-drugs followed for up to 2 years, and the clinical study analyses included 3,057 people with dementia, 374 of whom used Z-drugs, followed for up to 11 years.

According to Fox, new use of Z-drugs was linked to a 40% greater risk for fractures, with higher risk seen in those with higher cumulative dose. The results also showed that use of Z-drugs was tied to increased risk for hip fracture and mortality. The study did not identify a higher risk associated with other effects, such as falls, infection, stroke or venous thromboembolism. Furthermore, there was a dose-dependent rise in fracture risk with use of Z-drugs in patients with dementia as well, Fox noted.

“Our message is that Z-medicines should not be prescribed in people with dementia; or, if they have to be, there is enhanced surveillance of risk factors for falls in such patients and use of protection devices such as hip protectors,” Fox told Healio Psychiatry. “In sleep disturbance, evidence-based nonpharmacological alternatives should be considered initially given the devastating impact of fractures. Treatment decisions should also consider the impact of improved sleep on carer quality of life.” – by Savannah Demko

Reference:

Fox C, et al. Beyond anti-psychotics: Exploring efficacy and harms of Z-drugs for sleep disturbance on the progression of key dementia outcomes. Presented at: Alzheimer's Association International Conference; July 22-26, 2018, 2018; Chicago.

Disclosure: Fox reports no relevant financial disclosures.