@article{ref1,
title="Sedative hypnotics and the risk of falls and fractures in the elderly",
journal="Journal of clinical psychiatry",
year="2018",
author="Andrade, Chittaranjan",
volume="79",
number="3",
pages="e12340-e12340",
abstract="Older age, poor sleep, and the use of the &quot;Z&quot; sedative hypnotic drugs (zopiclone, eszopiclone, zolpidem, and zaleplon) commonly go together. Each of these can increase the risk of falls and fractures through mechanisms related to cognitive and psychomotor impairment. A recent systematic review and meta-analysis examined the risk of falls and fractures associated with the use of the Z-drugs. The authors of that meta-analysis identified 14 relevant cohort and case-control studies. They found that Z-drugs increased the risk of falls in 2 out of 3 studies that provided information on this outcome; in the third, the increased risk narrowly missed statistical significance. Z-drugs increased the fracture risk in 9 of 10 studies (odds ratio [OR] = 1.63; 95% confidence interval [CI], 1.42-1.87). In secondary analyses, the fracture risk associated with the use of Z-drugs was elevated in studies that included a control group diagnosed with insomnia (OR = 1.28; 95% CI, 1.08-1.53) as well as in studies of samples restricted to subjects aged > 65 years (OR = 1.70; 95% CI, 1.36-2.12). In 2 studies, zolpidem was associated with an increased risk of injuries. Whereas confounding by indication may explain a part of the risk of falls and fractures, there is reason to consider that Z-drugs augment the risk. Either way, the use of Z-drugs emerges as a clear marker for the risk of falls and fractures. Nonpharmacologic interventions for insomnia should therefore be considered as alternatives to the use of Z-drugs. Finally, patients prescribed Z-drugs and caregivers of these patients should be warned about the risk of falls and fractures and counseled about practical measures that can reduce the risk.<br><br>© Copyright 2018 Physicians Postgraduate Press, Inc.<p /> <p>Language: en</p>",
language="en",
issn="0160-6689",
doi="10.4088/JCP.18f12340",
url="http://dx.doi.org/10.4088/JCP.18f12340"
}