TY - JOUR

T1 - Use of hypnotic-sedative medication and risk of falls and fractures in adults

T2 - A self-controlled case series study

AU - Rozing, Maarten Pieter

AU - Wium-Andersen, Marie Kim

AU - Wium-Andersen, Ida Kim

AU - Jørgensen, Terese Sara Høj

AU - Jørgensen, Martin Balslev

AU - Osler, Merete

N1 - Publisher Copyright: © 2023 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.

PY - 2023

Y1 - 2023

N2 - Objective: To evaluate the risk of falls and fractures in users of benzodiazepines, Z-drugs, or melatonin. Methods: We followed 699,335 adults with a purchase of benzodiazepines, Z-drugs, or melatonin in the Danish National Prescription Registry between 2003 and 2016 for falls and fractures in the Danish National Patient Registry between 2000 and 2018. A self-controlled case-series analysis and conditional Poisson regression were used to derive incidence rate ratios (IRR) of falls and fractures during six predefined periods. Results: In total 62,105 and 36,808 adults, respectively, experienced a fall or fracture. For older adults, the risk of falls was highest during the 3-month pre-treatment period (IRRmen+70, 4.22 (95% confidence interval, 3.53–5.05), IRRwomen + 70, 3.03 (2.59–3.55)) compared to the baseline (>1 year before initiation). The risk continued to be higher in the later treatment periods. Contrarily, in men and women aged 40–69 years, the risk was only higher in the 3-month pre-treatment period. The incidence of falls among young men and women was slightly lower after initiation of sedating medication (treatment period, IRRmen15–39, 0.66 (0.50–0.86), IRRwomen15–39, 0.65 (0.51–0.83)). Analyses with fractures as outcome yielded similar results. Conclusions: Although falls and fractures occur more often in persons using sedative-hypnotic medication, the higher risk of falls and fractures in the pre-treatment period relative to the period directly after treatment, suggests that this association is better explained by other factors that elicited the prescription of this medication rather than the adverse effects of the sedative-hypnotic medication.

AB - Objective: To evaluate the risk of falls and fractures in users of benzodiazepines, Z-drugs, or melatonin. Methods: We followed 699,335 adults with a purchase of benzodiazepines, Z-drugs, or melatonin in the Danish National Prescription Registry between 2003 and 2016 for falls and fractures in the Danish National Patient Registry between 2000 and 2018. A self-controlled case-series analysis and conditional Poisson regression were used to derive incidence rate ratios (IRR) of falls and fractures during six predefined periods. Results: In total 62,105 and 36,808 adults, respectively, experienced a fall or fracture. For older adults, the risk of falls was highest during the 3-month pre-treatment period (IRRmen+70, 4.22 (95% confidence interval, 3.53–5.05), IRRwomen + 70, 3.03 (2.59–3.55)) compared to the baseline (>1 year before initiation). The risk continued to be higher in the later treatment periods. Contrarily, in men and women aged 40–69 years, the risk was only higher in the 3-month pre-treatment period. The incidence of falls among young men and women was slightly lower after initiation of sedating medication (treatment period, IRRmen15–39, 0.66 (0.50–0.86), IRRwomen15–39, 0.65 (0.51–0.83)). Analyses with fractures as outcome yielded similar results. Conclusions: Although falls and fractures occur more often in persons using sedative-hypnotic medication, the higher risk of falls and fractures in the pre-treatment period relative to the period directly after treatment, suggests that this association is better explained by other factors that elicited the prescription of this medication rather than the adverse effects of the sedative-hypnotic medication.

KW - benzodiazepines

KW - fall

KW - fracture

KW - melatonin

KW - sedative-hypnotic medication

KW - self-controlled design

KW - Z-drugs

U2 - 10.1111/acps.13610

DO - 10.1111/acps.13610

M3 - Journal article

C2 - 37665682

AN - SCOPUS:85169703330

VL - 148

JO - Acta Psychiatrica Scandinavica

JF - Acta Psychiatrica Scandinavica

SN - 0001-690X

IS - 5

ER -