Benzodiazepines and the Risk of Falling Leading to Femur Fractures: Dosage More Important Than Elimination Half-life

doi:10.1001/archinte.1995.00430160149015

You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.

Vol. 155 No. 16, 11 SEPTEMBER 1995

Online Only
	•	Online First Table of Contents

Original Investigations

•	Online Features

This Article
•	References
•	Full text PDF
•	Reply to article
•	Send to a friend
•	Save in My Folder
•	Save to citation manager
•	Permissions

Citing Articles
•	Citation map
•	Citing articles on HighWire
•	Citing articles on Web of Science (183)
•	Contact me when this article is cited

Related Content
•	Similar articles in this journal

Social Bookmarking
	What's this?

Benzodiazepines and the Risk of Falling Leading to Femur Fractures

Dosage More Important Than Elimination Half-life

Ron M. C. Herings, PhD; Bruno H. Ch. Stricker, PhD; Anthonius de Boer, PhD; Albert Bakker, PhD; Ferd Sturmans, PhD

Arch Intern Med. 1995;155(16):1801-1807.

Abstract

Background
In the past decade, the use of benzodiazepines has been identifiedas a major independent risk factor for accidental falls.

Objective
To study the role of dosing, timing, elimination half-life,and type of benzodiazepine in relation to the occurrence ofaccidental falls leading to hospitalization for femur fractures.

Methods
A 1:3 age-, sex-, and pharmacy-matched case-control study wasperformed using data from a Dutch record linkage system (PHARMO)(N=300 000). Cases included 493 patients (55 years and older),newly admitted to the hospital for a femur fracture resultingfrom an accidental fall (between 1986 and 1992). Relative riskestimates were calculated using conditional logistic regressionanalyses to control for the potential confounding effects ofconcomitant drug use and presence of a wide range of underlyingdiseases.

Results
Falls were significantly associated with current use of benzodiazepines(odds ratio, 1.6; 95% confidence interval, 1.2 to 2.1) and inparticular with short half-life benzodiazepines (odds ratio,1.5; 95% confidence interval, 1.1 to 2.0), sudden dose increases(odds ratio, 3.4; 95% confidence interval, 1.0 to 11.5),andconcomitant use of several benzodiazepines (odds ratio, 2.5;95% confidence interval, 1.3 to 4.9). A strong dose-responserelationship (P<.0001) and dose-response relations amongusers of either short or long half-life benzodiazepines suggeststhat these increased risks are explained primarily by dose.

Conclusions
Benzodiazepines are a major, independent risk factor for fallsleading to femur fractures, and the increased risk is probablyexplained by prescribing too-high doses to the elderly.

(Arch Intern Med. 1995;155:1801-1807)

Author Affiliations

From the Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht (the Netherlands) Institute for Pharmaceutical Sciences (UIPS), Utrecht University (Drs Herings, de Boer, and Bakker); Department of Internal Medicine II, Pharmacoepidemiology Unit, Erasmus University Rotterdam (the Netherlands) (Dr Stricker); and the Department of Epidemiology, Limburg University Faculty of Medicine, Maastricht, the Netherlands (Dr Sturmans).

Add to CiteULike CiteULike Add to Connotea Connotea Add to Delicious Delicious Add to Digg Digg Facebook Add to Reddit Reddit Add to Technorati Technorati Twitter What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Association between prescription medications and falls at home among young and middle-aged adults
Kool et al.
Inj. Prev. 2012;0:injuryprev-2011-040202v1-injuryprev-2011-040202.
ABSTRACT | FULL TEXT

Guided medication dosing for elderly emergency patients using real-time, computerized decision support
Griffey et al.
J Am Med Inform Assoc 2012;19:86-93.
ABSTRACT | FULL TEXT

Risk for Fractures with Centrally Acting Muscle Relaxants: An Analysis of a National Medicare Advantage Claims Database
Golden et al.
The Annals of Pharmacotherapy 2010;44:1369-1375.
ABSTRACT | FULL TEXT

Use of Organic Nitrates and the Risk of Hip Fracture: A Population-Based Case-Control Study
Pouwels et al.
J. Clin. Endocrinol. Metab. 2010;95:1924-1931.
ABSTRACT | FULL TEXT

Escitalopram for Older Adults With Generalized Anxiety Disorder: A Randomized Controlled Trial
Lenze et al.
JAMA 2009;301:295-303.
ABSTRACT | FULL TEXT

Healthcare Outcomes Associated with Beers' Criteria: A Systematic Review
Jano and Aparasu
The Annals of Pharmacotherapy 2007;41:438-447.
ABSTRACT | FULL TEXT

Effect of New York State Regulatory Action on Benzodiazepine Prescribing and Hip Fracture Rates
Wagner et al.
ANN INTERN MED 2007;146:96-103.
ABSTRACT | FULL TEXT

Psychotropic Medications and Risk for Falls Among Community-Dwelling Frail Older People: An Observational Study
Landi et al.
J Gerontol A Biol Sci Med Sci 2005;60:622-626.
ABSTRACT | FULL TEXT

Guided Prescription of Psychotropic Medications for Geriatric Inpatients
Peterson et al.
Arch Intern Med 2005;165:802-807.
ABSTRACT | FULL TEXT

Efficacy of temazepam in frequent users: a series of N-of-1 trials
Wegman et al.
Fam Pract 2005;22:152-159.
ABSTRACT | FULL TEXT

What's wrong with prescribing hypnotics?
DTB 2004;42:89-93.
ABSTRACT | FULL TEXT

Benzodiazepine Use and Hip Fractures in the Elderly: Who Is at Greatest Risk?
Wagner et al.
Arch Intern Med 2004;164:1567-1572.
ABSTRACT | FULL TEXT

Inhaled and Nasal Corticosteroid Use and the Risk of Fracture
Suissa et al.
Am. J. Respir. Crit. Care Med. 2004;169:83-88.
ABSTRACT | FULL TEXT

Limb Fractures in Elderly Men as Indicators of Subsequent Fracture Risk
Ettinger et al.
Arch Intern Med 2003;163:2741-2747.
ABSTRACT | FULL TEXT

Hypnotic Dependent Insomnia in an Older Adult with Addiction-Prone Personality
Cooper et al.
Clinical Case Studies 2003;2:247-258.
ABSTRACT

Central Nervous System Active Medications and Risk for Fractures in Older Women
Ensrud et al.
Arch Intern Med 2003;163:949-957.
ABSTRACT | FULL TEXT

Prescription Medications Associated with a Decreased Risk of Non-Hodgkin's Lymphoma
Beiderbeck et al.
Am J Epidemiol 2003;157:510-516.
ABSTRACT | FULL TEXT

Benzodiazepines and hip fractures in elderly people: case-control study
Pierfitte et al.
BMJ 2001;322:704-708.
ABSTRACT | FULL TEXT

HMG-CoA Reductase Inhibitors and the Risk of Hip Fractures in Elderly Patients
Wang et al.
JAMA 2000;283:3211-3216.
ABSTRACT | FULL TEXT

Meta-analysis of benzodiazepine use in the treatment of insomnia
Holbrook et al.
CMAJ 2000;162:225-233.
ABSTRACT | FULL TEXT

Taking Policy Action to Reduce Benzodiazepine Use and Promote Self-Care Among Seniors
Hall
Journal of Applied Gerontology 1998;17:318-351.
ABSTRACT

| | |