BMJ 2001;322:704-708 ( 24 March )

Papers

Benzodiazepines and hip fractures in elderly people: case-control study

Corinne Pierfitte, registrar, ^a Gerard Macouillard, consultant, ^b Michel Thicoïpe, consultant, ^c Anicet Chaslerie, registrar, ^a Fabienne Pehourcq, consultant, ^a Myriam Aïssou, research assistant, ^a Béatrice Martinez, laboratory technician, ^a Rajaa Lagnaoui, registrar, ^a Annie Fourrier, research epidemiologist, ^a Bernard Bégaud, professor, ^a Jacques Dangoumau, professor, ^a Nicholas Moore, professor. ^a

^a Département de Pharmacologie, Unité de Pharmacologie Clinique, Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux Cedex, France, ^b Département d'Anesthésie-Réanimation, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, ^c Services des Urgences, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux

Correspondence to: N Moore, Department of Pharmacology, Victor Segalen University, 33076 Bordeaux Cedex, France nicholas.moore{at}pharmaco.u-bordeaux2.fr

Objective: To determine whether benzodiazepines are associated with an increased risk of hip fracture.
Design: Case-control study.
Participants: All incident cases of hip fracture not related to traffic accidents or cancer in patients over 65 years of age. 245 cases were matched to 817 controls.
Setting: Emergency department of a university hospital.
Main outcome measures: Exposure to benzodiazepines and other potential risk or protective factors or lifestyle items.
Results: The use of benzodiazepines as determined from questionnaires, medical records, or plasma samples at admission to hospital was not associated with an increased risk of hip fracture (odds ratio 0.9, 95% confidence interval 0.5 to 1.5). Hip fracture was, however, associated with the use of two or more benzodiazepines, as determined from questionnaires or medical records but not from plasma samples. Of the individual drugs, only lorazepam was significantly associated with an increased risk of hip fracture (1.8, 1.1 to 3.1).
Conclusion: Except for lorazepam, the presence of benzodiazepines in plasma was not associated with an increased risk of hip fracture. The method used to ascertain exposure could influence the results of case-control studies.

What is already known on this topic Benzodiazepines increase the risk of elderly people falling in a dose dependent way Their role in hip fracture remains disputed, with increased risk sometimes attributed to drugs with a longer half life or those used to induce sleep What this study adds Benzodiazepines were not associated with hip fracture either as a group or according to half life or to characterisation as hypnotic or anxiolytic Patients using two or more benzodiazepines may be at higher risk Patients using lorazepam or certain other benzodiazepines may also be at a higher risk of fracture

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Rapid Responses:

Read all Rapid Responses

"Safety of benzodiazepines" not supported by data on hip fractures.

Andrew Byrne
bmj.com, 26 Mar 2001 [Full text]

Re: "Safety of benzodiazepines" not supported by data on hip fractures: author's response

Nicholas Moore
bmj.com, 29 Mar 2001 [Full text]

"Duration of exposure to benzodiazepine" should have been sought to improve validity of the study

S Hemanth Guptha
bmj.com, 30 Mar 2001 [Full text]

Bnezodiazepines do increase the risk of hip fracture

R M C Herings
bmj.com, 8 Apr 2001 [Full text]

Re: Bnezodiazepines do increase... Author's response

Nicholas Moore
bmj.com, 11 Apr 2001 [Full text]

Benzodiazepines and hip fractures: cracking evidence

Giovanni Gambassi
bmj.com, 20 Apr 2001 [Full text]

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