title: Nonbenzodiazepine Sedative Hypnotics and Risk of Fall-Related Injury.
abstract: The objective of this study was to test the hypothesis that use of zolpidem, eszopiclone, and zaleplon would be associated with increased risk of traumatic brain injury (TBI) and hip fracture.
  
  
  
  We conducted a case-crossover study on a 5% random sample of Medicare beneficiaries age 65 y or older hospitalized with either TBI (n = 15,031) or hip fracture (n = 37,833) during 2007-2009. Use of zolpidem, eszopiclone, or zaleplon during the 30-day period prior to injury hospitalization was compared to use during four control periods at 3, 6, 9, and 12 mo prior to injury. The primary outcome was hospitalization for TBI or hip fracture.
  
  
  
  Zolpidem use during the month prior to injury was associated with increased risk of TBI (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.56, 2.25); however, eszopiclone use during the same period was not associated with increased risk (OR 0.67; 95% CI 0.40, 1.13). Zolpidem use during the month prior to injury was associated with increased risk of hip fracture (OR 1.59; 95% CI 1.41, 1.79); however, eszopiclone use during the same period was not associated with increased risk (OR 1.12; 95% CI 0.83, 1.50). Analysis of zaleplon use in the month prior to injury was limited by low drug utilization but was not associated with increased risk of TBI (OR 0.85; 95% CI 0.21, 3.34) or hip fracture (OR 0.92; 95% CI 0.40, 2.13) in this study.
  
  
  
  For the treatment of insomnia in older adults, eszopiclone may present a safer alternative to zolpidem, in terms of fall-related injuries.
authors.affiliation: Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, Maryland.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Tom
authors.affiliation: Departments of Psychiatry and Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Emerson M
authors.initials: EM
authors.lastname: Wickwire
authors.affiliation: Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, Maryland.
authors.forename: Yujin
authors.initials: Y
authors.lastname: Park
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Albrecht
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000081:Acetamides / Q000009:adverse effects* / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology* / Q000209:etiology; D018592:Cross-Over Studies; D000069582:Eszopiclone / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D016017:Odds Ratio; D011725:Pyridines / Q000009:adverse effects* / Q000627:therapeutic use; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D018570:Risk Assessment; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D000077334:Zolpidem
chemical_list: D000081:Acetamides; D006993:Hypnotics and Sedatives; D011725:Pyridines; D011743:Pyrimidines; D000077334:Zolpidem; C085665:zaleplon; D000069582:Eszopiclone
keywords: hip fracture; nonbenzodiazepine sedative hypnotics (NBSH); traumatic brain injury