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Cited by 225Pharmaceutical Practices and Patient OutcomesBalance, Gait, and Falls PreventionHip and Femur Fractures

The DOI matches its Crossref record; 56 of the 58 references it cites were found in a registry or an index.

Benzodiazepines, Z-drugs and the risk of hip fracture: A systematic review and meta-analysis

Open access
Donnelly, Karen, Bracchi, Robert, Hewitt, Jonathan, Routledge, Philip A., Carter, Ben·2017·PLOS ONE
DOI 10.1371/journal.pone.0174730PMC PMC5407557
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Abstract

BACKGROUND: Hip fractures in the older person lead to an increased risk of mortality, poorer quality of life and increased morbidity. Benzodiazepine (BNZ) use is associated with increased hip fracture rate, consequently Z-drugs are fast becoming the physician's hypnotic prescription of choice yet data on their use is limited. We compared the risk of hip fracture associated with Z-drugs and BNZ medications, respectively, and examined if this risk varied with longer-term use. METHODS AND FINDINGS: We carried out a systematic review of the literature and meta-analysis. MEDLINE and SCOPUS were searched to identify studies involving BNZ or Z-drugs and the risk of hip fracture up to May 2015. Each included study was quality-assessed. A pooled relative risk of hip fracture was calculated using the generic inverse variance method, with a random effects model, with the length of hypnotic usage as a subgroup. Both BNZ, and Z-drug use respectively, were significantly associated with an increased risk of hip fracture (RR = 1.52, 95% CI 1.37-1.68; and RR = 1.90, 95% CI 1.68-2.13). Short-term use of BNZ and Z-drugs respectively, was also associated with the greatest risk of hip fracture (RR = 2.40, 95% CI 1.88-3.05 and RR = 2.39, 95% CI 1.74-3.29). CONCLUSIONS: There is strong evidence that both BNZ and Z-drugs are associated with an increased risk of hip fracture in the older person, and there is little difference between their respective risks. Patients newly prescribed these medicines are at the greatest risk of hip fracture. Clinicians and policy makers need to consider the increased risk of fallings and hip fracture particularly amongst new users of these medications.

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Crossref · 10.1371/journal.pone.0174730

Cites

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Figures

Fig 1 PRISMA flowchart: Study selection for systematic review and meta analysis.
Fig 1 PRISMA flowchart: Study selection for systematic review and meta analysis.CC BY · PubMed Central
Fig 2 The adjusted relative risk of hip fracture in participants who used BNZ, compared to people who did not, by the length of use.
Fig 2 The adjusted relative risk of hip fracture in participants who used BNZ, compared to people who did not, by the length of use.CC BY · PubMed Central
Fig 3 The adjusted relative risk of hip fracture in population-based studies of participants who used BNZ or a Z-drug, compared to people who did not.
Fig 3 The adjusted relative risk of hip fracture in population-based studies of participants who used BNZ or a Z-drug, compared to people who did not.CC BY · PubMed Central
Fig 4 The adjusted relative risk of hip fracture in participants who used a Z-drug, compared to people who did not, by the length of use.
Fig 4 The adjusted relative risk of hip fracture in participants who used a Z-drug, compared to people who did not, by the length of use.CC BY · PubMed Central

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Citations

Cites

Show all 58 references

Research works printed but not linked: 2

  1. J Boddaert, 2015, Hip fractures: Epidemiology and risk factors, Annales françaises de médecine d’urgence, 5, 119
  2. F Hoffmann, 2006, New use of benzodiazepines and the risk of hip fracture: A case-crossover study, Zeitschrift fur Gerontologie und Geriatrie, 39, 143

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Metadata

Authors
Donnelly, K., Bracchi, R., Hewitt, J., Routledge, P. A., & Carter, B.
Affiliations
  • University Hospital Llandough (GB)
  • Cardiff University (GB)
  • University of Nottingham (GB)
Corresponding author
Carter, Ben
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2017-04-27
Volume
12
Issue
4
Pages
e0174730
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0174730
PMC
PMC5407557
OpenAlex
W2600488841
Cited by
225
References
58
Citations by year
2026: 19 · 2025: 35 · 2024: 24 · 2023: 23 · 2022: 27 · 2021: 24 · 2020: 35 · 2019: 21 · 2018: 11 · 2017: 4
FWCI
2.22
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Research Portal (King's College London) (submittedVersion, cc-by)
Funders
  • South London and Maudsley NHS Foundation Trust
  • National Institute for Health and Care Research
  • King's College London
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
  • Health Sciences › Medicine › Surgery › Hip and Femur Fractures
Keywords
benzodiazepines, Z-drugs, hip fracture, older adults, hypnotics, fall risk, drug safety, duration of drug use, adverse drug reactions
MeSH terms
Zolpidem, Benzodiazepines, Hip Fractures, Humans, Pyridines

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