Nonbenzodiazepine hypnotics are associated with an increased risk of hip fracture in residential aged care facilities

Evaluation of: Berry SD, Lee Y, Cai S, Dore DD. Nonbenzodiazepine sleep medication use and hip fractures in nursing home residents. JAMA Intern. Med. 173(9), 754-761 (2013). Sleep disturbances and complaints about poor sleep are common among residents of aged care facilities. Nonbenzodiazepine (non-BZD) hypnotics are often prescribed to older individuals in preference to benzodiazepines. To establish whether the use of non-BZD hypnotics is associated with an increased risk of hip fracture, Berry et al. conducted a case-crossover study among 15,528 long-stay US nursing home residents with a hip fracture. Medicare hospitalization and pharmacy claims data were used for determining hip fractures and medication use, and the minimum data set was used to ascertain resident characteristics. Odds ratios (ORs) for hip fracture were estimated by comparing the use of non-BZD hypnotics 0-29 days before hip fracture (hazard period) with use of non-BZD hypnotics 60-89 days and 120-149 days before hip fracture (control periods). During the 18-month study period, non-BZD hypnotics were dispensed to 11 (n = 1715) of the residents with hip fracture. There was an increased risk of hip fracture within 30 days of using a non-BZD hypnotic (OR: 1.66; 95 CI: 1.45-1.90). The risk of hip fracture was higher among new users of non-BZD hypnotics (OR: 2.20; 95 CI: 1.76- 2.74) and in those requiring supervision or limited assistance to transfer, compared with those requiring full assistance to transfer (OR: 2.02 vs 1.43; p = 0.02). The present study did not directly compare the risk of hip fracture associated with non-BZD hypnotics and benzodiazepines. However, the results suggest that clinicians should continue to exercise caution when prescribing non-BZD hypnotics to residents of aged care facilities.