BMJ  2007;334:282-283 (10 February), doi:10.1136/bmj.334.7588.282-c

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Benzodiazepine restrictions did not affect hip fractures in older people

Concern over the widespread misuse of benzodiazepines prompted many US authorities to control access. New York was one of the first states to take action, and in 1989 the department of health insisted that doctors must issue all prescriptions for benzodiazepines in triplicate and despatch one copy to the authorities for surveillance purposes. Prescribing of benzodiazepines fell immediately by 44%, and prescribing to older people enrolled in the Medicaid healthcare scheme fell by more than half.

As benzodiazepines can make older people dizzy, unsteady, and vulnerable to falls, researchers and policy makers were expecting to see a parallel drop in the number of hip fractures in the state. But they did not. A recent study showed that the incidence of hip fractures among men and women aged over 65 did not decline despite the changes in benzodiazepine use. Hip fractures continued at about the same rate before and after New York's change in policy. Furthermore, the cumulative incidence of hip fracture in New York remained broadly similar to the incidence in neighbouring New Jersey, where authorities had not tried to control benzodiazepine prescribing.

The authors aren't sure why this natural experiment didn't work, unless benzodiazepines don't increase the risk of hip fractures. Another natural experiment is already under way and may provide the answer—in January last year all benzodiazepines were excluded from Medicare coverage.

References

Ann Intern Med 2007;146:96-103[Abstract/Full Text]

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