title: Potential impact of benzodiazepine use on the rate of hip fractures in five large European countries and the United States.
abstract: Benzodiazepine use increases the risk of falls and has been associated with an increased risk of hip fractures. Our aim was to estimate the possible population impact of the use of benzodiazepines on the rate of hip fracture in France, Germany, Italy, Spain, the United Kingdom, and the United States. We conducted a literature review to estimate the pooled relative risk (RR) for hip fractures and use of benzodiazepines. Prevalence rates of benzodiazepine use in 2009 were calculated for each country using the IMS MIDAS database and three public databases in Denmark, the Netherlands, and Norway. Both the RR and prevalence rates were used for calculation of population attributable risks (PARs) of hip fractures associated with benzodiazepine use. The literature review showed an increased risk of hip fractures in benzodiazepine users (RR = 1.4, 95 % CI 1.2-1.6). Rate of benzodiazepine use showed considerable differences between countries, ranging from 4.7 % to 22.3 % of population ever in a 1-year period. These are reflected in results for the PARs; estimated attributions of benzodiazepines to the rate of hip fractures were 1.8 %, 95 % CI 1.1-2.6 (Germany); 2.0 %, 95 % CI 1.2-2.8 (United Kingdom); 5.2 %, 95 % CI 3.2-7.3 (Italy); 7.4 %, 95 % CI 4.5-10.0 (France); 8.0 %, 95 % CI 4.9-11.0 (United States); and 8.2 %, 95 % CI 5.1-12.0 (Spain). PAR estimates suggest that the potential attribution of benzodiazepine use on the population rate of hip fractures in the five specified European countries and the United States varies between 1.8 % and 8.2 %. During the next phase of the IMI-PROTECT study, a comparison with individual patient data will show whether this approach is valid.
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, Utrecht, The Netherlands.
authors.forename: T P
authors.initials: TP
authors.lastname: Khong
authors.forename: F
authors.initials: F
authors.lastname: de Vries
authors.forename: J S B
authors.initials: JS
authors.lastname: Goldenberg
authors.forename: O H
authors.initials: OH
authors.lastname: Klungel
authors.forename: N J
authors.initials: NJ
authors.lastname: Robinson
authors.forename: Luisa
authors.initials: L
authors.lastname: Ibáñez
authors.forename: H
authors.initials: H
authors.lastname: Petri
mesh_terms: D001569:Benzodiazepines / Q000009:adverse effects*; D003718:Denmark; D005060:Europe / Q000453:epidemiology; D050723:Fractures, Bone / Q000139:chemically induced / Q000453:epidemiology*; D005602:France; D005858:Germany; D006620:Hip Fractures / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D007558:Italy; D015995:Prevalence; D012307:Risk Factors; D013030:Spain; D006113:United Kingdom; D014481:United States / Q000453:epidemiology
chemical_list: D001569:Benzodiazepines