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Benzodiazepines, Z-drugs and the risk of hip fracture: A systematic review and meta-analysis

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  • Karen Donnelly
  • Robert Bracchi
  • Jonathan Hewitt
  • Philip A Routledge
  • Ben Carter

Abstract

Background: Hip fractures in the older person lead to an increased risk of mortality, poorer quality of life and increased morbidity. Benzodiazepine (BNZ) use is associated with increased hip fracture rate, consequently Z-drugs are fast becoming the physician’s hypnotic prescription of choice yet data on their use is limited. We compared the risk of hip fracture associated with Z-drugs and BNZ medications, respectively, and examined if this risk varied with longer-term use. Methods and findings: We carried out a systematic review of the literature and meta-analysis. MEDLINE and SCOPUS were searched to identify studies involving BNZ or Z-drugs and the risk of hip fracture up to May 2015. Each included study was quality-assessed. A pooled relative risk of hip fracture was calculated using the generic inverse variance method, with a random effects model, with the length of hypnotic usage as a subgroup. Both BNZ, and Z-drug use respectively, were significantly associated with an increased risk of hip fracture (RR = 1.52, 95% CI 1.37–1.68; and RR = 1.90, 95% CI 1.68–2.13). Short-term use of BNZ and Z-drugs respectively, was also associated with the greatest risk of hip fracture (RR = 2.40, 95% CI 1.88–3.05 and RR = 2.39, 95% CI 1.74–3.29). Conclusions: There is strong evidence that both BNZ and Z-drugs are associated with an increased risk of hip fracture in the older person, and there is little difference between their respective risks. Patients newly prescribed these medicines are at the greatest risk of hip fracture. Clinicians and policy makers need to consider the increased risk of fallings and hip fracture particularly amongst new users of these medications.

Suggested Citation

  • Karen Donnelly & Robert Bracchi & Jonathan Hewitt & Philip A Routledge & Ben Carter, 2017. "Benzodiazepines, Z-drugs and the risk of hip fracture: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-14, April.
    • Handle: RePEc:plo:pone00:0174730
    DOI: 10.1371/journal.pone.0174730
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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    1. Bo-Ram Yang & Kyu-Nam Heo & Yun Mi Yu & Ga-Bin Yeom & Hye Duck Choi & Ju-Yeun Lee & Young-Mi Ah, 2021. "Interrupted Time Series Analysis of Changes in Zolpidem Use Due to Media Broadcasts," IJERPH, MDPI, vol. 18(10), pages 1-12, May.
    2. Clément Mathieu & Pierre Joly & Hélène Jacqmin-Gadda & Mathilde Wanneveich & Bernard Bégaud & Antoine Pariente, 2021. "Patterns of Benzodiazepine Use and Excess Risk of All-Cause Mortality in the Elderly: A Nationwide Cohort Study," Drug Safety, Springer, vol. 44(1), pages 53-62, January.
    3. Kjerstin Tevik & Geir Selbæk & Knut Engedal & Arnfinn Seim & Steinar Krokstad & Anne-S Helvik, 2019. "Mortality in older adults with frequent alcohol consumption and use of drugs with addiction potential – The Nord Trøndelag Health Study 2006-2008 (HUNT3), Norway, a population-based study," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-24, April.
    4. Yu Jiang & Qinghua Xia & Jie Wang & Peng Zhou & Shuo Jiang & Vinod K. Diwan & Biao Xu, 2019. "Insomnia, Benzodiazepine Use, and Falls among Residents in Long-term Care Facilities," IJERPH, MDPI, vol. 16(23), pages 1-11, November.

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