Is Zolpidem Associated with Increased Risk of Fractures in the Elderly with Sleep Disorders? A Nationwide Case Cross-Over Study in Taiwan

• Published in: PloS one 2015-12, Vol.10 (12), p.e0146030-e0146030
• Main Authors: Tang, Yih-Jing, Ho, Shinn-Ying, Chu, Fang-Ying, Chen, Hung-An, Yin, Yun-Ju, Lee, Hua-Chin, Chu, William Cheng-Chung, Yeh, Hui-Wen, Chiang, Wei-Shan, Yeh, Chia-Lun, Huang, Hui-Ling, Tzeng, Nian-Sheng
• Format: Article
• Language: English
• Subjects: Acute effects; Age Factors; Aged; Aged, 80 and over; Analysis; Antidepressants; Antipsychotics; Arthritis; Benzodiazepines; Benzodiazepines - adverse effects; Benzodiazepines - therapeutic use; Biocompatibility; Biomedical materials; Care and treatment; Case-Control Studies; Complications and side effects; Cross-Over Studies; Design; Diagnosis; Diazepam; Diuretics; Dosage and administration; Elderly; Female; Fractures; Fractures, Bone - chemically induced; Geriatrics; Health aspects; Health insurance; Hip; Humans; Hypertension; Hypnotics and Sedatives - adverse effects; Hypnotics and Sedatives - therapeutic use; Injuries; Insomnia; Male; Mental depression; Morbidity; Mortality; Older people; Osteoarthritis; Osteoporosis; Pyridines - adverse effects; Pyridines - therapeutic use; Rheumatoid arthritis; Risk analysis; Risk Factors; Science; Sleep; Sleep disorders; Sleep Wake Disorders - drug therapy; Spine; Taiwan; Womens health; Zolpidem
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0146030

We conducted a study using a case-crossover design to clarify the risk of acute effects of zolpidem and benzodiazepine on all-sites of fractures in the elderly. Case-crossover design. Elderly enrollees (n = 6010) in Taiwan's National Health Insurance Research Database with zolpidem or benzodiazepine use were analyzed for the risk of developing fractures. After adjusting for medications such as antipsychotics, antidepressants, and diuretics, or comorbidities such as hypertension, osteoarthritis, osteoporosis, rheumatoid arthritis and depression, neither zolpidem nor benzodiazepine was found to be associated with increased risk in all-sites fractures. Subjects without depression were found to have an increased risk of fractures. Diazepam is the only benzodiazepine with increased risk of fractures after adjusting for medications and comorbidities. Hip and spine were particular sites for increased fracture risk, but following adjustment for comorbidities, the associations were found to be insignificant. Neither zolpidem nor benzodiazepine was associated with increased risk of all-site fractures in this case cross-over study after adjusting for medications or comorbidities in elderly individuals with insomnia. Clinicians should balance the benefits and risks for prescribing zolpidem or benzodiazepine in the elderly accordingly.