title: Handgrip strength and balance in older adults following withdrawal from long-term use of temazepam, zopiclone or zolpidem as hypnotics.
abstract: BACKGROUND
  Benzodiazepines and related drugs affect physical functioning negatively and increase fall and fracture risk. As impaired muscle strength and balance are risk factors for falls, we examined the effects of hypnotic withdrawal on handgrip strength and balance in older adult outpatients during and after long-term use of temazepam, zopiclone and zolpidem (here collectively referred to as "benzodiazepines").
  
  
  METHODS
  Eighty-nine chronic users (59 women, 30 men) of temazepam, zopiclone or zolpidem aged ≥55 years participated in a benzodiazepine withdrawal study. Individual physician-directed withdrawal was performed gradually over a one-month period and participants were followed up to six months. Handgrip strength was assessed using a handheld dynamometer, and balance using the Short Berg's Balance Scale during the period of benzodiazepine use (baseline), and at 1, 2, 3 weeks, and 1, 2 and 6 months after initiating withdrawal. Withdrawal outcome and persistence were determined by plasma benzodiazepine-determinations at baseline and at four weeks ("short-term withdrawers", n = 69; "short-term non-withdrawers", n = 20), and by interviews at six months ("long-term withdrawers", n = 34; "long-term non-withdrawers", n = 55). Also most of the non-withdrawers markedly reduced their benzodiazepine use.
  
  
  RESULTS
  Within three weeks after initiating withdrawal, handgrip strength improved significantly (P ≤ 0.005) compared to baseline values. Among women, long-term withdrawers improved their handgrip strength both when compared to their baseline values (P = 0.001) or to non-withdrawers (P =0.004). In men, improvement of handgrip strength from baseline was not significantly better in withdrawers than in non-withdrawers. However, men did improve their handgrip strength values compared to baseline (P = 0.002). Compared to balance test results at baseline, withdrawers improved starting from the first week after withdrawal initiation. There was, however, only a borderline difference (P = 0.054) in balance improvement between the long-term withdrawers and long-term non-withdrawers. Of note, the non-withdrawers tended to improve their handgrip strength and balance compared to baseline values, in parallel with their reduced benzodiazepine use.
  
  
  CONCLUSIONS
  Withdrawal from long-term use of benzodiazepines can rapidly improve muscle strength and balance. Our results encourage discontinuing benzodiazepine hypnotics, particularly in older women who are at a high risk of falling and sustaining fractures.
  
  
  BACKGROUND
  EU Clinical Trials Register: EudraCT2008000679530. Registered 31 October 2008.
authors.affiliation: Department of Family Medicine, University of Turku, Lemminkäisenkatu 1, FI-20014 Turku, Finland. janurm@utu.fi.
authors.forename: Janne
authors.initials: J
authors.lastname: Nurminen
authors.forename: Juha
authors.initials: J
authors.lastname: Puustinen
authors.forename: Ritva
authors.initials: R
authors.lastname: Lähteenmäki
authors.forename: Tero
authors.initials: T
authors.lastname: Vahlberg
authors.forename: Alan
authors.initials: A
authors.lastname: Lyles
authors.forename: Markku
authors.initials: M
authors.lastname: Partinen
authors.forename: Ismo
authors.initials: I
authors.lastname: Räihä
authors.forename: Pertti J
authors.initials: PJ
authors.lastname: Neuvonen
authors.forename: Sirkka-Liisa
authors.initials: SL
authors.lastname: Kivelä
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D053961:Azabicyclo Compounds / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010879:Piperazines / Q000009:adverse effects*; D004856:Postural Balance / Q000502:physiology*; D011725:Pyridines / Q000009:adverse effects*; D020127:Recovery of Function / Q000502:physiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology* / Q000523:psychology; D013693:Temazepam / Q000009:adverse effects*; D013997:Time Factors; D000077334:Zolpidem
chemical_list: D053961:Azabicyclo Compounds; D006993:Hypnotics and Sedatives; D010879:Piperazines; D011725:Pyridines; C515050:zopiclone; D000077334:Zolpidem; D013693:Temazepam