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LETTERS:
Antonio Sgadari, Giovanni Gambassi, Claudio Pedone, and Graziano Onder
Study should have reported more data about associated diseases
BMJ 2001; 323: 112 [Full text]
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[Read Rapid Response] We agree
Nicholas Moore   (15 July 2001)

We agree 15 July 2001
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Nicholas Moore,
professor of Clinical Pharmacology
University of Bordeaux

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Re: We agree

Sir,

We were extremely pleased to note that in this very large case-control study of 9752 hip fractures vs 38564 controls (1), Sgadari et al also found no association between the use of benzodiazepines and hip fracture. Like us, but using different subgroups, they did find an association withe certain drugs and hip fracture. They looked at the metabolic pathways involved, and it appears that in a very specific subgroup of the most elderly patients these drugs may be more at risk. If it is not the result of multiple post-hoc testing, it is an interesting finding, and one we did not look at.

We tried to be careful and state that the results we found on individual drugs were subject to caution, because of the risk of spurious results related to multiple testing and statistical variability.

Beyond trying to look at small subgroups of drugs or individual agents, the main result is the same: overall there is no increased risk of fracture associated with benzodiazepines. The risk associated with the subgroups mentioned by these authors are minuscule, and only apparent because of the size of their study. This is in clear contrast with the important and constantly found , dose-dependent, increased risk of falling, for all products, which is consistent with their remarkably similar pharmacological properties.

I really think it is time to try to understand why and how benzodiazepines increase the risk of falling and not of breaking, rather than trying to concentrate on finding subgroups that do, each study finding a different subgroup(s).

Most sincerely,

N. Moore
Professor of Clinical Pharmacology
Université Victor segalen-Bordeaux2, Bordeaux, France

1. Sgadari A, Lapane KL, Mor V, Landi F, Bernabei R, Gambassi G. Oxidative and nonoxidative benzodiazepines and the risk of femur fracture. J Clin Psychopharmacol 2000; 20: 234-239[Medline].