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Benzodiazepines, Z-drugs and the risk of hip fracture: A systematic review and meta-analysis
Open accessAbstract
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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“Longer-term use is associated with a number of physical and cognitive risks, including physical dependence, tolerance, loss of efficacy, falls, and fractures ( Donnelly et al., 2017) and memory disturbance (Lister, 1985).”
From Pharmacological principles for safe benzodiazepine and Z-drug dose reduction (2026) · cites this paper as Donnelly et al., 2017
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Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859
Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series
(2008) · doi:10.1002/9780470712184 · Cited by 25,048
Wang, G., Ma, R., Qiao, G., Wada, K., Aizawa, Y., & Satoh, T. (2015) · Integrative Medicine International · doi:10.1159/000368408 · Cited by 18,762
Cochrane Handbook for Systematic Reviews of Interventions
Higgins, J. P. T., Green, S., & Ben Van Den, A. (2020) · International Coaching Psychology Review · doi:10.53841/bpsicpr.2020.15.2.123 · Cited by 5,670
Cochrane Handbook for Systematic Reviews of Interventions
Tarsilla, M. (2010) · Journal of MultiDisciplinary Evaluation · doi:10.56645/jmde.v6i14.284 · Cited by 5,232
Risk Factors for Hip Fracture in White Women
Cummings, S. R., Nevitt, M. C., Browner, W. S., Stone, K., Fox, K. M., Ensrud, K. E., Cauley, J., Black, D., & Vogt, T. M. (1995) · New England Journal of Medicine · doi:10.1056/nejm199503233321202 · Cited by 3,595
Chapter 9: Analysing Data and Undertaking Meta-Analyses
Deeks, J. J., Higgins, J. P. T., & Altman, D. G. (2008) · Cited by 2,782
Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits
Glass, J., Lanctôt, K. L., Herrmann, N., Sproule, B. A., & Busto, U. E. (2005) · BMJ · doi:10.1136/bmj.38623.768588.47 · Cited by 1,161
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- J Boddaert, 2015, Hip fractures: Epidemiology and risk factors, Annales françaises de médecine d’urgence, 5, 119
- 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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Items 201–223 of 223
Okuda, S., Qureshi, Z. P., Yanagida, Y., Ito, C., Homma, Y., & Tokita, S. (2024) · Figshare · doi:10.6084/m9.figshare.26583900
Richardson, K., Loke, Y. K., Fox, C., Maidment, I., Howard, R. J., Steel, N., Arthur, A., Boyd, P. J., Aldus, C. F., Ballard, C. G., et al. (2020) · Figshare · doi:10.6084/m9.figshare.13279110
Evrard, P., Pétein, C., Beuscart, J.-B., & Spinewine, A. (2022) · Figshare · doi:10.6084/m9.figshare.20279392
Richardson, K., Loke, Y. K., Fox, C., Maidment, I., Howard, R. J., Steel, N., Arthur, A., Boyd, P. J., Aldus, C. F., Ballard, C. G., et al. (2020) · Figshare · doi:10.6084/m9.figshare.13279101
Evrard, P., Pétein, C., Beuscart, J.-B., & Spinewine, A. (2022) · Figshare · doi:10.6084/m9.figshare.20279383
Richardson, K., Loke, Y. K., Fox, C., Maidment, I., Howard, R. J., Steel, N., Arthur, A., Boyd, P. J., Aldus, C. F., Ballard, C. G., et al. (2020) · Figshare · doi:10.6084/m9.figshare.13279104
Association between skeletal fractures and sleep medication in patients with chronic kidney disease
Onogi, C., Watanabe, Y., Tanaka, A., Furuhashi, K., Ito, E., & Maruyama, S. (2026) · BMC Nephrology · doi:10.1186/s12882-025-04725-9
Young, B., Zhuang, T., Fernando, N. K., Manner, P. A., Kamal, R. N., & Hernandez, N. M. (2025) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/jaaos-d-25-00888
BeProGuide: A Behavior Design Guide to De-Implement Low-Value Clinical Practices (Preprint)Preprint
Gómez‐Zúñiga, B., Armayones, M., & Pousada, M. (2026) · doi:10.2196/preprints.96637
Fan, Z.-Q., Gao, Y.-S., Chen, Y.-H., Zhang, J. M., Lu, W., Yang, D., Xiang, X., Liu, J., Yu, K., & Chen, Y. (2026) · EXPLORE · doi:10.1016/j.explore.2026.103421
Love, E. S. H., Jónsdóttir, F., & Sigurdsson, M. I. (2026) · Scientific Reports · doi:10.1038/s41598-026-49262-z
Swain, J., Carter, D., Vando, L., & Reardon, I. (2026) · Research Square · doi:10.21203/rs.3.rs-9553669/v1
Chen, Y., Shen, P., Zhou, G. H., Xu, W., Wan, Y., & Wang, C. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1835295
Osada, H., Hotta, S., Yoshimi, A., Mizoguchi, H., Noda, Y., & Ikesue, H. (2026) · Iryo Yakugaku (Japanese Journal of Pharmaceutical Health Care and Sciences) · doi:10.5649/jjphcs.52.262
Carreres, T. D. P., Conesa, G. M., & Navarrete, F. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1841866
Polypharmacy and Drug Interactions in Older Patients
Eng, C. C., VanMeter, E., & Heavner, M. S. (2026) · Respiratory medicine · doi:10.1007/978-3-032-29861-4_5
Liu, Y., Bell, J. S., Ea, A. M. L., Cui, M., Chan, H., Hoda, F., & Cross, A. J. (2026) · Australian Journal on Ageing · doi:10.1111/ajag.70210
Aoki, S., Kimiwada, M., Hoshino, T., Koike, K., Akada, H., Saiga, T., Sato, S., Shinkai, R., Shibata, Y., & Tomita, T. (2026) · Sleep and Biological Rhythms · doi:10.1007/s41105-026-00675-3
Initial Z-Drug Prescription Duration and Long-Term Use
Cloughesy, J. N., Thunell, J. A., Liu, X., Persell, S. D., Linder, J. A., Sullivan, M. D., & Doctor, J. N. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.32006
Watt, J. A., Sharma, S., Huang, Y. Q., Jones, A., Nicholson, K., Yu, A. Y., Straus, S. E., DiPaolo, M. T., Kapral, M. K., & Vyas, M. V. (2026) · Age and Ageing · doi:10.1093/ageing/afag267
Insomnia treatment preferences of older adults and people living with dementia: A qualitative study
McEvoy, A. M., Reeve, E., Ride, J., Langford, A. V., Lee, K. M. K., Loh, S., & Turner, J. P. (2026) · Journal of Alzheimer s Disease · doi:10.1177/13872877261487350
Rusin, I., Wrzesińska, A., Korowacki, M., Przybylski, M., Świrad, B., Mączka, K., Kazimierczak, K., Grobecki, D., Kruczek, F., & Dyczko, J. (2026) · International Journal of Innovative Technologies in Social Science · doi:10.31435/ijitss.3(51).2026.5859
Kleinert, M.-L., Atighetchi, S., Beck, J. I., Bolt, L., Stalder, O., Romskaug, R., Callegari, E., Maldonado, L. F., Basseda, R. M., Kaznowski, M., et al. (2026) · BMJ Open · doi:10.1136/bmjopen-2026-123804
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
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-04-27
- Volume
- 12
- Issue
- 4
- Pages
- e0174730
- ISSN
- 1932-6203 (ISSN-L)
- 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
- gold
- doi.org
- 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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