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Use of short-acting and long-acting hypnotics and the risk of fracture: a critical analysis of associations in a nationwide cohort

SUMMARY: Numerous observational studies suggest that hypnotics increase the risk of fractures, and long-acting hypnotics are suggested to be especially harmful. This study showed that the highest risk of fracture was found before start of treatment and remained after end of therapy, suggesting that...

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Autores principales: Nordström, P., Nordström, A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer London 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795622/
https://www.ncbi.nlm.nih.gov/pubmed/31363793
http://dx.doi.org/10.1007/s00198-019-05085-5
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author Nordström, P.
Nordström, A.
author_facet Nordström, P.
Nordström, A.
author_sort Nordström, P.
collection PubMed
description SUMMARY: Numerous observational studies suggest that hypnotics increase the risk of fractures, and long-acting hypnotics are suggested to be especially harmful. This study showed that the highest risk of fracture was found before start of treatment and remained after end of therapy, suggesting that the increased risk during treatment is influenced by other factors, such as underlying disease. INTRODUCTION: The purpose of this study was to evaluate associations between the use of short-acting and long-acting hypnotics and the risk of fracture. METHODS: Four cohorts were formed from all individuals living in Sweden aged ≥ 50 years in 2005 (n = 3,341,706). In the first cohort, individuals prescribed long-acting propiomazine (n = 233,609) were matched 1:1 with controls. In the second cohort, individuals prescribed short-acting z-drugs (zopiclone, zolpidem, and zaleplon, n = 591,136) were matched 1:1 with controls. The third and fourth cohorts consisted of full sibling pairs with discordant propiomazine (n = 83,594) and z-drug (n = 153,314) use, respectively. RESULTS: The risk of fracture was greatest among users of hypnotics in the 90 days before the initiation of treatment, both for propiomazine (odds ratio [OR], 2.52; 95% confidence interval [CI], 2.28–2.79) and z-drugs (OR, 4.10; 95% CI, 3.86–4.35) compared with that in matched controls. Furthermore, this risk was significantly reduced after the initiation of treatment with propiomazine (OR, 1.42; 95% CI, 1.27–1.60) and z-drugs (OR, 1.67; 95% CI, 1.56–1.80) and remained the first year following the last prescribed dose both for propiomazine (OR, 1.28, 95% CI, 1.21–1.36) and z-drugs (OR, 1.19, 95% CI, 1.16–1.23). The pattern was similar in the sibling cohorts, with the greatest risk of fracture seen in the 90 days before treatment with hypnotics was initiated. CONCLUSION: The use of short-acting and long-acting hypnotics is associated with an increased risk of fracture. This risk was highest before initiation of treatment and remained after end of therapy. The results suggest that the increased risk during treatment is influenced by other factors such as underlying disease.
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spelling pubmed-67956222019-10-25 Use of short-acting and long-acting hypnotics and the risk of fracture: a critical analysis of associations in a nationwide cohort Nordström, P. Nordström, A. Osteoporos Int Original Article SUMMARY: Numerous observational studies suggest that hypnotics increase the risk of fractures, and long-acting hypnotics are suggested to be especially harmful. This study showed that the highest risk of fracture was found before start of treatment and remained after end of therapy, suggesting that the increased risk during treatment is influenced by other factors, such as underlying disease. INTRODUCTION: The purpose of this study was to evaluate associations between the use of short-acting and long-acting hypnotics and the risk of fracture. METHODS: Four cohorts were formed from all individuals living in Sweden aged ≥ 50 years in 2005 (n = 3,341,706). In the first cohort, individuals prescribed long-acting propiomazine (n = 233,609) were matched 1:1 with controls. In the second cohort, individuals prescribed short-acting z-drugs (zopiclone, zolpidem, and zaleplon, n = 591,136) were matched 1:1 with controls. The third and fourth cohorts consisted of full sibling pairs with discordant propiomazine (n = 83,594) and z-drug (n = 153,314) use, respectively. RESULTS: The risk of fracture was greatest among users of hypnotics in the 90 days before the initiation of treatment, both for propiomazine (odds ratio [OR], 2.52; 95% confidence interval [CI], 2.28–2.79) and z-drugs (OR, 4.10; 95% CI, 3.86–4.35) compared with that in matched controls. Furthermore, this risk was significantly reduced after the initiation of treatment with propiomazine (OR, 1.42; 95% CI, 1.27–1.60) and z-drugs (OR, 1.67; 95% CI, 1.56–1.80) and remained the first year following the last prescribed dose both for propiomazine (OR, 1.28, 95% CI, 1.21–1.36) and z-drugs (OR, 1.19, 95% CI, 1.16–1.23). The pattern was similar in the sibling cohorts, with the greatest risk of fracture seen in the 90 days before treatment with hypnotics was initiated. CONCLUSION: The use of short-acting and long-acting hypnotics is associated with an increased risk of fracture. This risk was highest before initiation of treatment and remained after end of therapy. The results suggest that the increased risk during treatment is influenced by other factors such as underlying disease. Springer London 2019-07-30 2019 /pmc/articles/PMC6795622/ /pubmed/31363793 http://dx.doi.org/10.1007/s00198-019-05085-5 Text en © The Author(s) 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Nordström, P.
Nordström, A.
Use of short-acting and long-acting hypnotics and the risk of fracture: a critical analysis of associations in a nationwide cohort
title Use of short-acting and long-acting hypnotics and the risk of fracture: a critical analysis of associations in a nationwide cohort
title_full Use of short-acting and long-acting hypnotics and the risk of fracture: a critical analysis of associations in a nationwide cohort
title_fullStr Use of short-acting and long-acting hypnotics and the risk of fracture: a critical analysis of associations in a nationwide cohort
title_full_unstemmed Use of short-acting and long-acting hypnotics and the risk of fracture: a critical analysis of associations in a nationwide cohort
title_short Use of short-acting and long-acting hypnotics and the risk of fracture: a critical analysis of associations in a nationwide cohort
title_sort use of short-acting and long-acting hypnotics and the risk of fracture: a critical analysis of associations in a nationwide cohort
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795622/
https://www.ncbi.nlm.nih.gov/pubmed/31363793
http://dx.doi.org/10.1007/s00198-019-05085-5
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