Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, 90185, Umeå, Sweden.
Department of Public Health and Clinical Medicine, Environmental Medicine, Umeå University, 90185, Umeå, Sweden.
Osteoporos Int. 2019 Oct;30(10):1983-1993. doi: 10.1007/s00198-019-05085-5. Epub 2019 Jul 30.
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.
The purpose of this study was to evaluate associations between the use of short-acting and long-acting hypnotics and the risk of fracture.
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.
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.
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.
本研究旨在评估短期和长期催眠药使用与骨折风险之间的关系。
从 2005 年瑞典所有年龄≥50 岁的个体中组成了 4 个队列（n=3341706）。在第一个队列中，将服用长效丙咪嗪的个体（n=233609）与对照者进行 1:1 匹配。在第二个队列中，将服用短效 Z 类药物（佐匹克隆、唑吡坦和扎来普隆）的个体与对照者进行 1:1 匹配（n=591136）。第三和第四个队列分别由接受丙咪嗪（n=83594）和 Z 类药物（n=153314）治疗的非同卵双胞胎组成。
在治疗开始前的 90 天内，催眠药物使用者的骨折风险最高，丙咪嗪（比值比[OR]，2.52；95%置信区间[CI]，2.28-2.79）和 Z 类药物（OR，4.10；95%CI，3.86-4.35）均高于匹配对照者。此外，与治疗开始前相比，丙咪嗪（OR，1.42；95%CI，1.27-1.60）和 Z 类药物（OR，1.67；95%CI，1.56-1.80）的风险显著降低，且在最后一次处方剂量后第一年仍保持不变，丙咪嗪（OR，1.28，95%CI，1.21-1.36）和 Z 类药物（OR，1.19，95%CI，1.16-1.23）。在同卵双胞胎队列中，这种模式也很相似，在开始使用催眠药物治疗的 90 天内，骨折风险最高。
短期和长期催眠药物的使用与骨折风险增加有关。这种风险在开始治疗前最高，在治疗结束后仍然存在。结果表明，治疗期间的风险增加受到其他因素的影响，如潜在疾病。
