Saarelainen Laura, Tolppanen Anna-Maija, Koponen Marjaana, Tanskanen Antti, Sund Reijo, Tiihonen Jari, Hartikainen Sirpa, Taipale Heidi
Kuopio Research Center for Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Research Center for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland.
J Am Med Dir Assoc. 2017 Jan;18(1):87.e15-87.e21. doi: 10.1016/j.jamda.2016.09.019. Epub 2016 Nov 12.
To investigate the association between benzodiazepine and related drug (BZDR) use and hip fracture as well as postfracture mortality and duration of hospital stay in community-dwellers with and without Alzheimer disease (AD).
Retrospective cohort study.
The register-based Medication Use and Alzheimer's disease (MEDALZ) study, including all community-dwelling persons diagnosed with AD in Finland during 2005-2011 (n = 70,718) and their matched comparison persons without AD.
Persons without BZDR use during the year preceding the AD diagnosis or the corresponding matching date as well as persons without history of hip fracture were included in this study.
We investigated the risk of hip fracture associated with BZDR use compared with nonuse separately in persons with and without AD. Further, we investigated the association between BZDR use during hip fracture and 1-year mortality as well as longer than a 4-month hospital stay after hip fracture. Associations were reported as hazard ratios and odds ratios with 95% confidence intervals (CI).
BZDR use was associated with an increased risk of hip fracture in persons with and without AD (adjusted hazard ratio 1.4 [95% CI 1.2-1.7] and 1.6 [95% CI 1.3-1.9], respectively). BZDR use during hip fracture was associated with longer than 4-month postfracture hospital stay in persons with AD [adjusted odds ratio 1.9 (95% CI 1.3-2.8)] but not in comparison persons. One-year mortality was not associated with BZDR use during hip fracture.
Higher threshold in prescribing BZDRs for neuropsychiatric symptoms might decrease the hip fracture rate and affect the length of hospital stay in persons with AD.
探讨苯二氮䓬类及相关药物（BZDR）的使用与髋部骨折、骨折后死亡率以及社区中患与未患阿尔茨海默病（AD）者住院时间之间的关联。
回顾性队列研究。
基于登记的药物使用与阿尔茨海默病（MEDALZ）研究，纳入2005 - 2011年期间芬兰所有诊断为AD的社区居民（n = 70718）及其匹配的未患AD的对照人群。
本研究纳入在AD诊断前一年或相应匹配日期未使用BZDR且无髋部骨折病史的人群。
我们分别研究了使用与未使用BZDR的AD患者和非AD患者髋部骨折的风险。此外，我们还研究了髋部骨折期间使用BZDR与1年死亡率以及髋部骨折后住院超过4个月之间的关联。关联结果以风险比和优势比及95%置信区间（CI）表示。
使用BZDR与患与未患AD者髋部骨折风险增加相关（调整后风险比分别为1.4 [95%CI 1.2 - 1.7]和1.6 [95%CI 1.3 - 1.9]）。髋部骨折期间使用BZDR与AD患者骨折后住院超过4个月相关[调整后优势比1.9（95%CI 1.3 - 2.8）]，但在对照人群中无此关联。髋部骨折期间使用BZDR与1年死亡率无关。
对于神经精神症状，提高开具BZDR的阈值可能会降低髋部骨折率，并影响AD患者的住院时间。
