title: Risk of fractures requiring hospitalization after an initial prescription for zolpidem, alprazolam, lorazepam, or diazepam in older adults.
abstract: OBJECTIVE
  To determine whether zolpidem is a safer alternative to benzodiazepines.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Community based.
  
  
  METHODS
  Health maintenance organization members with an initial prescription for zolpidem (n = 43,343), alprazolam (n = 103,790), lorazepam (n = 150,858), or diazepam (n = 93,618).
  
  
  METHODS
  Zolpidem and benzodiazepine prescriptions were identified from pharmacy databases. Rates of nonvertebral fractures and hip fractures requiring hospitalization were compared before and after an initial prescription for each treatment, adjusting for confounders using doubly robust estimation.
  
  
  RESULTS
  In patients aged 65 and older, the rates of nonvertebral fractures and dislocations were similar in the pre- treatment intervals. The rate ratios (RRs) for the 90-day posttreatment interval relative to the pretreatment interval were 2.55 (95% confidence interval (CI) = 1.78-3.65; P < .001) for zolpidem, 1.14 (95% CI = 0.80-1.64; P = .42) for alprazolam, 1.53 (95% CI = 1.23-1.91; P < .001) for lorazepam, and 1.97 (95% CI = 1.22-3.18; P = .01) for diazepam. The ratio of RRs (RRR)-the RR in the posttreatment period adjusted for the corresponding RR in the pretreatment period-were 2.23 (95% CI = 1.36-3.66; P = .006) for zolpidem relative to alprazolam, 1.68 (95% CI = 1.12-2.53; P = .02) for zolpidem relative to lorazepam, and 1.29 (95% CI = 0.72-2.30; P = .32) for zolpidem relative to diazepam. The RRs decreased with time from the initial prescription (trend P < .001), as would be expected if the association is causal.
  
  
  CONCLUSIONS
  In older adults, the risk of injury with zolpidem exceeded that with alprazolam and lorazepam and was similar to that with diazepam. If the associations are causal, then the high incidence of these fractures implies that these treatment induce a substantial number of fractures and consequential costs. Further study of the association is imperative.
authors.affiliation: Consolidated Research, Inc., Los Angeles, California, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Finkle
authors.forename: Jane S
authors.initials: JS
authors.lastname: Der
authors.forename: Sander
authors.initials: S
authors.lastname: Greenland
authors.forename: John L
authors.initials: JL
authors.lastname: Adams
authors.forename: Gregory
authors.initials: G
authors.lastname: Ridgeway
authors.forename: Terrance
authors.initials: T
authors.lastname: Blaschke
authors.forename: Zixia
authors.initials: Z
authors.lastname: Wang
authors.forename: Richard M
authors.initials: RM
authors.lastname: Dell
authors.forename: Kurt B
authors.initials: KB
authors.lastname: VanRiper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000525:Alprazolam / Q000009:adverse effects* / Q000627:therapeutic use; D015984:Causality; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003975:Diazepam / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006306:Health Surveys; D006620:Hip Fractures / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D004204:Joint Dislocations / Q000453:epidemiology*; D008140:Lorazepam / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D016017:Odds Ratio; D011725:Pyridines / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012306:Risk; D013223:Statistics as Topic; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem; D008140:Lorazepam; D003975:Diazepam; D000525:Alprazolam