title: Is Zolpidem Associated with Increased Risk of Fractures in the Elderly with Sleep Disorders? A Nationwide Case Cross-Over Study in Taiwan.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Case-crossover design.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Family Medicine, Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.|School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Yih-Jing
authors.initials: YJ
authors.lastname: Tang
authors.affiliation: Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan.|Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
authors.forename: Shinn-Ying
authors.initials: SY
authors.lastname: Ho
authors.affiliation: Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
authors.forename: Fang-Ying
authors.initials: FY
authors.lastname: Chu
authors.affiliation: Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
authors.forename: Hung-An
authors.initials: HA
authors.lastname: Chen
authors.affiliation: Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
authors.forename: Yun-Ju
authors.initials: YJ
authors.lastname: Yin
authors.affiliation: Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
authors.forename: Hua-Chin
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Department of Computer Science, Tunghai University, Taichung, Taiwan.
authors.forename: William Cheng-Chung
authors.initials: WC
authors.lastname: Chu
authors.affiliation: Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.|Department of Nursing, Tri-Service General Hospital, School of Nursing, National Defense Medical Center, Taipei, Taiwan.|Institute and Department of Mathematics, National Tamkang University, New Taipei City, Taiwan.
authors.forename: Hui-Wen
authors.initials: HW
authors.lastname: Yeh
authors.affiliation: Institute and Department of Mathematics, National Tamkang University, New Taipei City, Taiwan.|Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Wei-Shan
authors.initials: WS
authors.lastname: Chiang
authors.affiliation: Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
authors.forename: Chia-Lun
authors.initials: CL
authors.lastname: Yeh
authors.affiliation: Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan.|Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Huang
authors.affiliation: Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.|Student Counseling Center, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Nian-Sheng
authors.initials: NS
authors.lastname: Tzeng
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D016022:Case-Control Studies; D018592:Cross-Over Studies; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D011725:Pyridines / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000188:drug therapy*; D013624:Taiwan; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D001569:Benzodiazepines; D000077334:Zolpidem