J Prev Med Public Health.  2012 Jul;45(4):219-226. 10.3961/jpmph.2012.45.4.219.

Zolpidem Use and Risk of Fracture in Elderly Insomnia Patients

• Kang DY
• Park S
• Rhee CW
• Kim YJ
• Choi NK
• Lee J
• Park BJ

• KMID: 1383785
• DOI: http://doi.org/10.3961/jpmph.2012.45.4.219

Abstract

OBJECTIVES
To evaluate the risk of fractures related with zolpidem in elderly insomnia patients.
METHODS
Health claims data on the entire South Korean elderly population from January 2005 to June 2006 were extracted from the Health Insurance Review and Assessment Service database. We applied a case-crossover design. Cases were defined as insomnia patients who had a fracture diagnosis. We set the hazard period of 1 day length prior to the fracture date and four control periods of the same length at 5, 10, 15, and 20 weeks prior to the fracture date. Time independent confounding factors such as age, gender, lifestyle, cognitive function level, mobility, socioeconomic status, residential environment, and comorbidity could be controlled using the casecrossover design. Time dependent confounding factors, especially co-medication of patients during the study period, were adjusted by conditional logistic regression analysis. The odds ratios and their 95% confidence intervals (CIs) were estimated for the risk of fracture related to zolpidem.
RESULTS
One thousand five hundred and eight cases of fracture were detected in insomnia patients during the study period. In our data, the use of zolpidem increased the risk of fracture significantly (adjusted odds ratio [aOR], 1.72; 95% CI, 1.37 to 2.16). However, the association between benzodiazepine hypnotics and the risk of fracture was not statistically significant (aOR, 1.00; 95% CI, 0.83 to 1.21). Likewise, the results were not statistically significant in stratified analysis with each benzodiazepine generic subgroup.
CONCLUSIONS
Zolpidem could increase the risk of fracture in elderly insomnia patients. Therefore zolpidem should be prescribed carefully and the elderly should be provided with sufficient patient education.

Keyword

Zolpidem; Bone fractures; Case-crossover design; Aged; Hypnotic; Sleep initiation and maintenance disorders

MeSH Terms

Aged
Aged, 80 and over
Benzodiazepines/adverse effects/therapeutic use
Cross-Over Studies
Female
Fractures, Bone/chemically induced/*epidemiology
Humans
Hypnotics and Sedatives/adverse effects/therapeutic use
Male
Odds Ratio
Pyridines/*adverse effects/*therapeutic use
Republic of Korea/epidemiology
Risk Assessment
Risk Factors
Sleep Initiation and Maintenance Disorders/*drug therapy