Prescribing Advice for GPs

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Hypnotics raise hip fracture risk

JAMA Internal Medicine (formerly the Archives of Internal Medicine) has published the results of an observational study that aimed to assess the relationship between sleep medication use and injurious falls in nursing home residents.

The study review data for 15,528 patients who were long stay residents in nursing homes in America with a documented hip fracture between July 2007 and December 2008. The patients were reviewed for exposure to non-benzodiazepine hypnotic drugs before the hip fracture with 1,715 (11.0%) of participants being dispensed such a medication. The risk of hip fracture was elevated in users of non-benzodiazepine hypnotic drugs compared to non-users (OR 1.66, 95% CI 1.45-1.90).

The association was also stronger for new users of non-benzodiazepine hypnotic drugs (OR 2.20, 95% CI 1.76-2.74), those with moderate to severe cognitive impairment compared to mild impairment (OR 1.86 versus 1.43, P=0.06) and those who require full assistance with transfers (OR, 2.02 versus 1.43, P=0.02).

The authors conclude that, "caution should be exercised when prescribing sleep medications to nursing home residents".

The authors note some limitations in this study. The analysis did not include assessment of the drug dose used or any impact of traditional benzodiazepines. Also, the severity and impact of the insomnia on hip fracture risk could not be separated from drug use in the analysis.

Action: Clinicians should be aware of this analysis. While the findings are not surprising they provide a reminder to use hypnotics cautiously in those at higher risk of falling.

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