Risk of Fractures Requiring Hospitalization After an Initial Prescription for Zolpidem, Alprazolam, Lorazepam, or Diazepam in Older Adults
Risk of Fractures Requiring Hospitalization After an Initial Prescription for Zolpidem, Alprazolam, Lorazepam, or Diazepam in Older Adults
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DOI：
10.1111/j.1532-5415.2011.03591.x
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发表时间：
2011-10-01
影响因子：
6.3
通讯作者：
VanRiper, Kurt B.
中科院分区：
文献类型：
--
作者：
Finkle, William D.;Der, Jane S.;VanRiper, Kurt B.
目的：设计：回顾性队列研究，以社区为基础，参与者：首次使用唑吡坦处方的健康维护组织成员（n = 43，343），阿普唑仑（n = 103，790）、劳拉西泮（n = 150，858）或地西泮（n = 93，618）。非椎骨骨折和髋部骨折需要住院治疗的比率进行了比较之前和之后的初始处方为每个treatment，调整混杂因素使用double robust estimation.RESULTS：在65岁及以上的患者，非椎骨骨折和脱位的比率是相似的预处理间隔。治疗后90天间隔相对于治疗前间隔的率比（RR）为2.55（95%置信区间（CI）= 1.78-3.65; P < .001），唑吡坦为1.14阿普唑仑为1.53（95% CI = 1.23-1.91; P < .001），地西泮为1.97（95% CI = 1.22-3.18; P = .01）。RR的比率（RRR）-治疗后阶段的RR调整为治疗前阶段的相应RR-为2.23（95% CI = 1.36-3.66; P = .006）唑吡坦相对于阿普唑仑，1.68（95% CI = 1.12-2.53; P = .02），唑吡坦相对于劳拉西泮为1.29（95% CI = 0.72-2.30; P = .32）。RR从最初的处方（趋势P < .001），随着时间的推移而下降，如果协会是cause.CONCLUSION：在老年人中，唑吡坦损伤的风险超过了阿普唑仑和劳拉西泮，与地西泮相似。如果相关性是因果关系，那么这些骨折的高发生率意味着这些治疗会引起大量骨折和相应的费用。因此，对这种关联的进一步研究势在必行。J Am Geriatr Soc 59：1883-1890，2011.
OBJECTIVES: To determine whether zolpidem is a safer alternative to benzodiazepines.DESIGN: Retrospective cohort study.SETTING: Community based.PARTICIPANTS: Health maintenance organization members with an initial prescription for zolpidem (n = 43,343), alprazolam (n = 103,790), lorazepam (n = 150,858), or diazepam (n = 93,618).MEASUREMENTS: Zolpidem and benzodiazepine prescriptions were identified from pharmacy databases. Rates of nonvertebral fractures and hip fractures requiring hospitalization were compared before and after an initial prescription for each treatment, adjusting for confounders using doubly robust estimation.RESULTS: In patients aged 65 and older, the rates of non-vertebral fractures and dislocations were similar in the pretreatment intervals. The rate ratios (RRs) for the 90-day posttreatment interval relative to the pretreatment interval were 2.55 (95% confidence interval (CI) = 1.78-3.65; P < .001) for zolpidem, 1.14 (95% CI = 0.80-1.64; P = .42) for alprazolam, 1.53 (95% CI = 1.23-1.91; P < .001) for lorazepam, and 1.97 (95% CI = 1.22-3.18; P = .01) for diazepam. The ratio of RRs (RRR)-the RR in the posttreatment period adjusted for the corresponding RR in the pretreatment period-were 2.23 (95% CI = 1.36-3.66; P = .006) for zolpidem relative to alprazolam, 1.68 (95% CI = 1.12-2.53; P = .02) for zolpidem relative to lorazepam, and 1.29 (95% CI = 0.72-2.30; P = .32) for zolpidem relative to diazepam. The RRs decreased with time from the initial prescription (trend P < .001), as would be expected if the association is causal.CONCLUSION: In older adults, the risk of injury with zolpidem exceeded that with alprazolam and lorazepam and was similar to that with diazepam. If the associations are causal, then the high incidence of these fractures implies that these treatment induce a substantial number of fractures and consequential costs. Further study of the association is imperative. J Am Geriatr Soc 59:1883-1890, 2011.