Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via HighWire Citing Articles via Google Scholar Articles by Wang, P. S. Articles by Avorn, J. Search for Related Content PubMed Citation Articles by Wang, P. S. Articles by Avorn, J. Geriatric Psychiatry Other Delivery of Care Anxiolytics

Hazardous Benzodiazepine Regimens in the Elderly: Effects of Half-Life, Dosage, and Duration on Risk of Hip Fracture

OBJECTIVE: While benzodiazepine treatment is known to increase the risk of hip fracture in older populations, controversy persists over which characteristics of benzodiazepine use (e.g., elimination half-life, dosage, duration of use) are most associated with such risks. METHOD: The authors reviewed the health care utilization data of 1,222 hip fracture patients and 4,888 comparison patients frequency matched on the basis of age and gender (all were at least 65 years old). Patients were enrolled in Medicare as well as in the New Jersey Medicaid or Pharmaceutical Assistance to the Aged and Disabled programs. Benzodiazepine use, as well as other covariates, were assessed before the index date (which was either the date of hospital admission for hip fracture surgical repair or, for the comparison subjects, a randomly assigned, frequency-matched date). RESULTS: All benzodiazepine doses 3 mg/day in diazepam equivalents significantly increased the adjusted risk of hip fracture by 50%. Significantly increased adjusted risks of hip fracture were seen during the initial 2 weeks of use (60% increase) and after more than 1 month of continuous use (80% increase) but not for 2–4 weeks of continuous use. Use of benzodiazepines other than long-acting agents significantly increased the risk of hip fracture by 50%. CONCLUSIONS: Even at modest doses, including some low doses currently advocated in prescribing guidelines for older patients, treatment with benzodiazepines appears to increase the risk of hip fracture. Patients appear to be particularly vulnerable immediately after initiating therapy and after more than 1 month of continuous use. Benzodiazepines with shorter half-lives appear to be no safer than longer half-life agents. Clinicians should be aware of these risks and weigh them against potential benefits when prescribing for elderly patients.

This article has been cited by other articles:

				F. Formiga and A. L. Soto Characteristics of Falls-Related Hip Fracture in Institutionalized Elderly Patients J Gerontol A Biol Sci Med Sci, May 4, 2009; (2009) glp059v1. [Full Text] [PDF]

				S. Hartikainen, E. Lonnroos, and K. Louhivuori Medication as a Risk Factor for Falls: Critical Systematic Review J. Gerontol. A Biol. Sci. Med. Sci., October 1, 2007; 62(10): 1172 - 1181. [Abstract] [Full Text] [PDF]

				D. J. Greenblatt, J. S. Harmatz, and A. Karim Age and Gender Effects on the Pharmacokinetics and Pharmacodynamics of Ramelteon, a Hypnotic Agent Acting via Melatonin Receptors MT1 and MT2 J. Clin. Pharmacol., April 1, 2007; 47(4): 485 - 496. [Abstract] [Full Text] [PDF]

				A. K. Wagner, D. Ross-Degnan, J. H. Gurwitz, F. Zhang, D. B. Gilden, L. Cosler, and S. B. Soumerai Effect of New York State Regulatory Action on Benzodiazepine Prescribing and Hip Fracture Rates Ann Intern Med, January 16, 2007; 146(2): 96 - 103. [Abstract] [Full Text] [PDF]

				P. Midlov, A. Bondesson, T. Eriksson, C. Nerbrand, and P. Hoglund Effects of educational outreach visits on prescribing of benzodiazepines and antipsychotic drugs to elderly patients in primary health care in southern Sweden Fam. Pract., February 1, 2006; 23(1): 60 - 64. [Abstract] [Full Text] [PDF]

				C. Alford and J. Verster NICE review: not nice for patients! J Psychopharmacol, March 1, 2005; 19(2): 129 - 132. [PDF]

				M. A. Schuckit and T. L. Smith CHANGES OVER TIME IN THE SELF-REPORTED LEVEL OF RESPONSE TO ALCOHOL Alcohol Alcohol., September 1, 2004; 39(5): 433 - 438. [Abstract] [Full Text] [PDF]

				E. A. Hoge, J. E. Oppenheimer, and N. M. Simon Generalized Anxiety Disorder Focus, July 1, 2004; 2(3): 346 - 359. [Full Text] [PDF]

				D. S. Chutka, P. Y. Takahashi, and R. W. Hoel Inappropriate Medications for Elderly Patients Mayo Clin. Proc., January 1, 2004; 79(1): 122 - 139. [Abstract] [PDF]

				B. L. Svarstad and J. K. Mount Effects of Residents' Depression, Sleep, and Demand for Medication on Benzodiazepine Use in Nursing Homes Psychiatr Serv, September 1, 2002; 53(9): 1159 - 1165. [Abstract] [Full Text] [PDF]

				More on Benzodiazepines and Hip Fractures Journal Watch Psychiatry, August 22, 2001; 2001(822): 17 - 17. [Full Text]

				More on Benzodiazepines and Hip Fractures Journal Watch (General), June 29, 2001; 2001(629): 3 - 3. [Full Text]

Get information about faster international access.

Privacy Policy

Copyright © 2001 American Psychiatric Association. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us