Hazardous benzodiazepine regimens in the elderly: Effects of half-life, dosage, and duration on risk of hip fracture
Hazardous benzodiazepine regimens in the elderly: Effects of half-life, dosage, and duration on risk of hip fracture
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DOI：
10.1176/appi.ajp.158.6.892
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发表时间：
2001-06-01
影响因子：
17.7
通讯作者：
Avorn, J
中科院分区：
文献类型：
--
作者：
Wang, PS;Bohn, RL;Avorn, J
目的：虽然已知苯二氮卓类药物治疗会增加老年人群髋部骨折的风险，但对于苯二氮卓类药物使用的哪些特征（例如消除半衰期、剂量、使用持续时间）与此类风险最相关仍存在争议。方法：作者回顾了 1,222 名髋部骨折患者和 4,888 名根据年龄频率匹配的对照患者的医疗保健利用数据 和性别（所有人都至少 65 岁）。患者参加了医疗保险以及新泽西州医疗补助或老年人和残疾人药物援助计划。苯二氮卓类药物的使用以及其他协变量在索引日期（即髋部骨折手术修复入院日期，或者对于比较受试者而言是随机分配的频率匹配日期）之前进行评估。结果：所有大于或等于地西泮当量每天 3 毫克的苯二氮卓类药物剂量均显着增加髋部骨折的调整风险 50%。在使用的最初 2 周内（增加 60%）和连续使用超过 1 个月后（增加 80%），髋部骨折的调整风险显着增加，但连续使用 2-4 周则没有。使用长效药物以外的苯二氮卓类药物会显着增加髋部骨折的风险 50%。结论：即使使用适度剂量，包括目前老年患者处方指南中提倡的一些低剂量，苯二氮卓类药物治疗似乎也会增加髋部骨折的风险。在开始治疗后和连续使用超过 1 个月后，患者似乎特别容易受到伤害。半衰期较短的苯二氮卓类药物似乎并不比半衰期较长的药物更安全。临床医生在为老年患者开药时应意识到这些风险，并权衡其与潜在益处。
Objective: While benzodiazepine treatment is known to increase the risk of hip fracture in older populations, controversy persists over which characteristics of benzodiazepine use (e.g., elimination half-life, dosage, duration of use) are most associated with such risks.Method: The authors reviewed the health care utilization data of 1,222 hip fracture patients and 4,888 comparison patients frequency matched on the basis of age and gender (all were at least 65 years old). Patients were enrolled in Medicare as well as in the New Jersey Medicaid or Pharmaceutical Assistance to the Aged and Disabled programs. Benzodiazepine use, as well as other covariates, were assessed before the index date (which was either the date of hospital admission for hip fracture surgical repair or, for the comparison subjects, a randomly assigned, frequency matched date).Results: All benzodiazepine doses greater than or equal to3 mg/ day in diazepam equivalents significantly increased the adjusted risk of hip fracture by 50%. Significantly increased adjusted risks of hip fracture were seen during the initial 2 weeks of use (60% increase) and after more than 1 month of continuous use (80% increase) but not for 2-4 weeks of continuous use. Use of benzodiazepines other than long-acting agents significantly increased the risk of hip fracture by 50%.Conclusions: Even at modest doses, including some low doses currently advocated in prescribing guidelines for older patients, treatment with benzodiazepines appears to increase the risk of hip fracture. Patients appear to be particularly vulnerable immediately after initiating therapy and after more than 1 month of continuous use. Benzodiazepines with shorter half-lives appear to be no safer than longer half-life agents. Clinicians should be aware of these risks and weigh them against potential benefits when prescribing for elderly patients.