Psychotropic Drug Use and the Risk of Hip Fracture

Ray, Wayne A.; Griffin, Marie R.; Schaffner, William; Baugh, David K.; Melton, L. Joseph

doi:10.1056/nejm198702123160702

Cited by 907 publications

(299 citation statements)

References 17 publications

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“…We did not find any interaction between individuals clinically at risk for OSAS, hypnotics intake, and mortality, suggesting that if hypnotics trigger or aggravate OSAS they do not impact on mortality risk. The use of BZD may also favor falls and hip fractures and thus increase the risk for disability and death especially in the elderly [41,42]. However some studies have suggested that nighttime sleep problems may also be significant risk factors for falls in the elderly, independently of hypnotic use [43][44][45].…”

Section: Discussionmentioning

confidence: 99%

Hypnotics and mortality in an elderly general population: A 12-year prospective study

et al. 2013

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Background: Hypnotics are widely used by the elderly, and their impact on mortality remains controversial. The inconsistent findings could be due to methodological limitations, notably the lack of control for underlying sleep symptoms or illness associated with hypnotic use, for example, insomnia symptoms and excessive daytime sleepiness, depression and anxiety. Our objective was to examine the association between the use of hypnotics and mortality risk in a large cohort of community-dwelling elderly, taking into account a wide range of potential competing risks including sociodemographic characteristics, lifestyle, and chronic disorders as well as underlying psychiatric disorders and sleep complaints. Methods: Analyses were carried out on 6,696 participants aged 65 years or older randomly recruited from three French cities and free of dementia at baseline. Adjusted Cox proportional hazards models with delayed entry, and age of the participants as the time scale, were used to determine the association between hypnotic use and 12-year survival. Results: At baseline, 21.7% of the participants regularly used at least one hypnotic. During follow-up, 1,307 persons died, 480 from cancer and 344 from cardiovascular disease. Analyses adjusted for study center, age and gender showed a significantly greater risk of all-cause and cardiovascular-related mortality with hypnotics, particularly benzodiazepines, and this increased with the number of hypnotics used. None of these associations were significant in models adjusting for sociodemographic and lifestyle characteristics, chronic disorders including cardiovascular pathologies, sleep and psychiatric disorders. Results remained unchanged when duration of past hypnotic intake or persistent versus intermittent use during follow-up were taken into account. Conclusions: When controlling for a large range of potential confounders, the risk of mortality was not significantly associated with hypnotic use regardless of the type and duration. Underlying psychiatric disorders appear to be the principal confounders of the observed association.

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Section: Discussionmentioning

confidence: 99%

Hypnotics and mortality in an elderly general population: A 12-year prospective study

et al. 2013

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“…Benzodiazepínicos têm sido associados a um aumento no risco de quedas e fraturas em diversos estudos individuais (Grisso et al, 1991;Jensen et al, 1991;Ray et al, 1987Ray et al, , 1989Ryynänen, 1993), assim como numa meta-aná-lise (Leipzig et al, 1999a).…”

Section: Discussionunclassified

“…Com isso, esses indivíduos estão mais sujeitos a apresentar tonteiras, ataxia, confusão, levando ao risco aumentado de quedas. A redução da massa muscular e da densidade óssea acarreta uma (Ray et al, 1987). Os resultados que associam o uso de bloqueadores de canal de cálcio a quedas e fraturas entre idosos são inconsistentes.…”

Section: Discussionunclassified

Uso de medicamentos como fator de risco para fratura grave decorrente de queda em idosos

Coutinho

Silva

2002

Cad. Saúde Pública

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Quedas seguidas de fraturas entre idosos constituem um importante problema de saúde pública. Um estudo caso-controle foi conduzido para avaliar o papel do uso de um conjunto de medicamentos, como fator de risco para esses acidentes entre pessoas com 60 anos ou mais, na cidade do Rio de Janeiro, Brasil. Cento e sessenta e nove casos de internação por fratura conseqüente a queda, e 315 controles hospitalares foram pareados por idade, sexo e hospital. Odds ratios (OR), ajustados por fatores potenciais de confusão, foram obtidos utilizando-se regressão logística condicional. Observou-se um aumento no risco desses acidentes para o uso de drogas bloqueadoras dos canais de cálcio (OR = 1,96, 1,16-3,30) e benzodiazepínicos (OR = 2,09, 1,08-4,05), e uma redução para o uso de diuréticos (OR = 0,40, 0,20-0,80). Antiácidos, digitálicos e laxantes mostraram-se associados a uma redução do risco de fraturas por quedas, cuja significância estatística atingiu níveis limítrofes (0,05 < p < 0,10). Os dados deste estudo apontam para a necessidade de ponderar os riscos e benefícios no uso de medicamentos em idosos, e orientar tais indivíduos e seus familiares para evitar esses acidentes quando o uso desses medicamentos é necessário.

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“…• Diazepam should not be prescribed for elderly patients, since this long-acting benzodiazepine drug exposes them to the risk of falls and hip fracture. 29 • Enoxaparin: the advantages of this lowmolecular-weight heparin over conventional treatment with heparin are questionable, 30,31 especially when considering that enoxaparin is so many times more expensive than heparin. The safety of enoxaparin has not been established for this age group.…”

Section: Drug Selectionmentioning

confidence: 99%

Point prevalence of drug prescriptions for elderly and non-elderly inpatients in a teaching hospital

et al. 2004

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CONTEXT: Age-related pharmacokinetic and pharmacodynamic changes have been extensively documented, and several concurrent diseases may underlie multiple drug therapy in the elderly. As a result, the risk of adverse drug reactions and drug interactions increases among aged patients. However, only a few studies have compared the prescribing patterns for different age groups of hospitalized patients or have evaluated the effect of age on drug prescription. OBJECTIVE: To compare the prevalence of drug prescriptions for elderly inpatients, with those for non-elderly inpatients, in order to assess age-related differences in the number of prescribed drugs, drug choices and prescribed doses, and to evaluate the prescription appropriateness for the elderly patients. TYPE OF STUDY: Cross-sectional survey. SETTING: 400-bed tertiary care general teaching hospital. PARTICIPANTS: All inpatients on one day of June 1995, except for the Intensive Care Unit and for the Departments of Psychiatry, Pediatrics and Obstetrics and Gynecology. PROCEDURES: All medicines prescribed to the eligible patients on the study day were recorded from the prescription sheets provided by the hospital pharmacy. MAIN MEASUREMENTS: Name, therapeutic class, and mean daily dose of the prescribed drugs. RESULTS: Of the 273 eligible inpatients, 46.5% were 14-44 years old, 33% were 45-64 years old and 20.5% were > 64 years old. Cancer was significantly more frequent among the elderly. The mean number of prescribed drugs was five for all age groups. The five most prescribed drugs for all patients were dipyrone, ranitidine, dipyrone in a fixed-dose combination, metoclopramide and cefazolin. The elderly had significantly more prescriptions for insulin, furosemide and enoxaparin. For most drugs, the mean prescribed dose showed that there was no dose adjustment for elderly patients, and drug choices for this age group were sometimes questionable. CONCLUSIONS: There was little variation in the prescribing patterns for the elderly when compared with the other age strata.

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Psychotropic Drug Use and the Risk of Hip Fracture

Cited by 907 publications

References 17 publications

Hypnotics and mortality in an elderly general population: A 12-year prospective study

Hypnotics and mortality in an elderly general population: A 12-year prospective study

Uso de medicamentos como fator de risco para fratura grave decorrente de queda em idosos

Point prevalence of drug prescriptions for elderly and non-elderly inpatients in a teaching hospital

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