title: Risk of Hip Fracture in Benzodiazepine Users With and Without Alzheimer Disease.
abstract: To investigate the association between benzodiazepine and related drug (BZDR) use and hip fracture as well as postfracture mortality and duration of hospital stay in community-dwellers with and without Alzheimer disease (AD).
  
  
  
  Retrospective cohort study.
  
  
  
  The register-based Medication Use and Alzheimer's disease (MEDALZ) study, including all community-dwelling persons diagnosed with AD in Finland during 2005-2011 (n = 70,718) and their matched comparison persons without AD.
  
  
  
  Persons without BZDR use during the year preceding the AD diagnosis or the corresponding matching date as well as persons without history of hip fracture were included in this study.
  
  
  
  We investigated the risk of hip fracture associated with BZDR use compared with nonuse separately in persons with and without AD. Further, we investigated the association between BZDR use during hip fracture and 1-year mortality as well as longer than a 4-month hospital stay after hip fracture. Associations were reported as hazard ratios and odds ratios with 95% confidence intervals (CI).
  
  
  
  BZDR use was associated with an increased risk of hip fracture in persons with and without AD (adjusted hazard ratio 1.4 [95% CI 1.2-1.7] and 1.6 [95% CI 1.3-1.9], respectively). BZDR use during hip fracture was associated with longer than 4-month postfracture hospital stay in persons with AD [adjusted odds ratio 1.9 (95% CI 1.3-2.8)] but not in comparison persons. One-year mortality was not associated with BZDR use during hip fracture.
  
  
  
  Higher threshold in prescribing BZDRs for neuropsychiatric symptoms might decrease the hip fracture rate and affect the length of hospital stay in persons with AD.
authors.affiliation: Kuopio Research Center for Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland. Electronic address: laura.saarelainen@uef.fi.
authors.forename: Laura
authors.initials: L
authors.lastname: Saarelainen
authors.affiliation: School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Research Center for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland.
authors.forename: Anna-Maija
authors.initials: AM
authors.lastname: Tolppanen
authors.affiliation: Kuopio Research Center for Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
authors.forename: Marjaana
authors.initials: M
authors.lastname: Koponen
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Impact Assessment Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Tanskanen
authors.affiliation: Department of Social Research, University of Helsinki, Helsinki, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Reijo
authors.initials: R
authors.lastname: Sund
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Tiihonen
authors.affiliation: Kuopio Research Center for Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Sirpa
authors.initials: S
authors.lastname: Hartikainen
authors.affiliation: Kuopio Research Center for Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Heidi
authors.initials: H
authors.lastname: Taipale
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000523:psychology; D001569:Benzodiazepines / Q000009:adverse effects*; D005260:Female; D005387:Finland; D006620:Hip Fractures / Q000209:etiology*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*
chemical_list: D001569:Benzodiazepines
keywords: Alzheimer disease; benzodiazepines; drug safety; hip fracture; postfracture hospital care; prescription register