Clinical Investigations

Risk of Fractures Requiring Hospitalization After an Initial Prescription for Zolpidem, Alprazolam, Lorazepam, or Diazepam in Older Adults

  1. William D. Finkle PhD1,
  2. Jane S. Der MS2,
  3. Sander Greenland DrPH3,
  4. John L. Adams PhD1,
  5. Gregory Ridgeway PhD1,
  6. Terrance Blaschke MD4,
  7. Zixia Wang MS2,
  8. Richard M. Dell MD5,
  9. Kurt B. VanRiper PharmD2,*

Article first published online: 21 SEP 2011

DOI: 10.1111/j.1532-5415.2011.03591.x

Issue

Journal of the American Geriatrics Society

Journal of the American Geriatrics Society

Volume 59, Issue 10, pages 1883–1890, October 2011

Additional Information

How to Cite

Finkle, W. D., Der, J. S., Greenland, S., Adams, J. L., Ridgeway, G., Blaschke, T., Wang, Z., Dell, R. M. and VanRiper, K. B. (2011), Risk of Fractures Requiring Hospitalization After an Initial Prescription for Zolpidem, Alprazolam, Lorazepam, or Diazepam in Older Adults. Journal of the American Geriatrics Society, 59: 1883–1890. doi: 10.1111/j.1532-5415.2011.03591.x

Author Information

  1. 1

    Consolidated Research, Inc., Los Angeles, California

  2. 2

    Pharmacy Analytical Services, Kaiser Foundation Health Plan and Hospitals, Southern California, Downey, California

  3. 3

    Epidemiology and Statistics, University of California, Los Angeles, California

  4. 4

    School of Medicine, Stanford University, Palo Alto, California

  5. 5

    Department of Orthopedics, Kaiser Permanente Downey Medical Center, Downey, California

*Address correspondence to Kurt VanRiper, PharmD, Pharmacy Analytical Services, Kaiser Foundation Health Plan and Hospitals, Southern California, 9521 Dalen Street, Downey CA, 90242. E-mail: Kurt.B.Vanriper@kp.org

Publication History

  1. Issue published online: 18 OCT 2011
  2. Article first published online: 21 SEP 2011

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Keywords:

  • zolpidem;
  • benzodiazepines;
  • injury

Objectives

To determine whether zolpidem is a safer alternative to benzodiazepines.

Design

Retrospective cohort study.

Setting

Community based.

Participants

Health maintenance organization members with an initial prescription for zolpidem (n = 43,343), alprazolam (n = 103,790), lorazepam (n = 150,858), or diazepam (n = 93,618).

Measurements

Zolpidem and benzodiazepine prescriptions were identified from pharmacy databases. Rates of nonvertebral fractures and hip fractures requiring hospitalization were compared before and after an initial prescription for each treatment, adjusting for confounders using doubly robust estimation.

Results

In patients aged 65 and older, the rates of nonvertebral fractures and dislocations were similar in the pre- treatment intervals. The rate ratios (RRs) for the 90-day posttreatment interval relative to the pretreatment interval were 2.55 (95% confidence interval (CI) = 1.78–3.65; P < .001) for zolpidem, 1.14 (95% CI = 0.80–1.64; P = .42) for alprazolam, 1.53 (95% CI = 1.23–1.91; P < .001) for lorazepam, and 1.97 (95% CI = 1.22–3.18; P = .01) for diazepam. The ratio of RRs (RRR)—the RR in the posttreatment period adjusted for the corresponding RR in the pretreatment period—were 2.23 (95% CI = 1.36–3.66; P = .006) for zolpidem relative to alprazolam, 1.68 (95% CI = 1.12–2.53; P = .02) for zolpidem relative to lorazepam, and 1.29 (95% CI = 0.72–2.30; P = .32) for zolpidem relative to diazepam. The RRs decreased with time from the initial prescription (trend P < .001), as would be expected if the association is causal.

Conclusion

In older adults, the risk of injury with zolpidem exceeded that with alprazolam and lorazepam and was similar to that with diazepam. If the associations are causal, then the high incidence of these fractures implies that these treatment induce a substantial number of fractures and consequential costs. Further study of the association is imperative.

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