Department of Epidemiology, Mailman School of Public Health and
Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.
Pediatrics. 2020 Jul;146(1). doi: 10.1542/peds.2019-3478. Epub 2020 Jun 4.
Benzodiazepines are commonly prescribed to treat anxiety disorders and have been associated with falls and fractures in older adults. It is unknown whether benzodiazepines increase fracture risk in youth. We examined whether youth with anxiety disorders initiating benzodiazepine treatment have an increased risk of fractures compared with youth initiating selective serotonin reuptake inhibitors (SSRIs).
We used claims from commercially insured children (6-17 years) and young adults (18-24) with a recent anxiety disorder diagnosis, initiating benzodiazepines or SSRIs (2008-2016). Youth were followed until fracture, treatment discontinuation or switching, disenrollment, 3 months, or December 31, 2016. The primary end point was diagnostic codes for upper and lower limb fractures. Incident fracture rates, incident rate ratios (IRRs), and incident rate differences (IRDs) were estimated with propensity score inverse probability of treatment weighting.
The cohort included 120 715 children and 179 768 young adults. In children, crude fracture rates during treatment were 33.1 per 1000 person-years (PYs) for benzodiazepine initiators and 25.1 per 1000 PYs for SSRI initiators. Adjusted IRR and IRD were 1.53 (95% confidence interval [CI]: 0.94-2.50) and 13.4 per 1000 PYs. Risk was heightened in children initiating long-acting benzodiazepines versus SSRIs (adjusted IRR = 2.30 [95% CI: 1.08-4.91]). Fracture rates were lower in young adults, with minimal differences between treatments (adjusted IRR = 0.85 [95% CI: 0.57-1.27]; adjusted IRD = -1.3 per 1000 PYs).
An increased rate of fractures in children, but not young adults, with anxiety disorders initiating benzodiazepine treatment compared to SSRI treatment suggests a need for increased caution in the weeks after benzodiazepine initiation in children.
苯二氮䓬类药物常用于治疗焦虑症，与老年人的跌倒和骨折有关。目前尚不清楚苯二氮䓬类药物是否会增加青少年的骨折风险。我们研究了患有焦虑症的青少年开始使用苯二氮䓬类药物治疗与开始使用选择性 5-羟色胺再摄取抑制剂 (SSRIs) 治疗相比，是否会增加骨折风险。
我们使用了 2008 年至 2016 年期间有近期焦虑症诊断、开始使用苯二氮䓬类药物或 SSRIs 的商业保险儿童（6-17 岁）和年轻人（18-24 岁）的理赔数据。青少年在骨折、治疗停药或换药、退出、3 个月或 2016 年 12 月 31 日前接受随访。主要终点是上下肢骨折的诊断代码。采用倾向评分逆概率治疗加权法估计发病率骨折率、发病率比值比 (IRR) 和发病率差异 (IRD)。
该队列包括 120715 名儿童和 179768 名年轻人。在儿童中，苯二氮䓬类药物治疗期间的骨折粗发生率为每 1000 人年 33.1 例，SSRIs 治疗期间为每 1000 人年 25.1 例。调整后的 IRR 和 IRD 分别为 1.53（95%置信区间[CI]：0.94-2.50）和 13.4 每 1000 人年。与 SSRIs 相比，起始长效苯二氮䓬类药物的儿童风险更高（调整后的 IRR = 2.30[95%CI：1.08-4.91]）。年轻人的骨折发生率较低，治疗之间差异极小（调整后的 IRR = 0.85[95%CI：0.57-1.27]；调整后的 IRD =-1.3 每 1000 人年）。
与 SSRIs 治疗相比，患有焦虑症的儿童在开始使用苯二氮䓬类药物治疗时，骨折发生率增加，而年轻人则没有，这表明在儿童开始使用苯二氮䓬类药物后的几周内需要更加小心。
