The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark.
Acta Psychiatr Scand. 2023 Nov;148(5):394-404. doi: 10.1111/acps.13610. Epub 2023 Sep 4.
To evaluate the risk of falls and fractures in users of benzodiazepines, Z-drugs, or melatonin.
We followed 699,335 adults with a purchase of benzodiazepines, Z-drugs, or melatonin in the Danish National Prescription Registry between 2003 and 2016 for falls and fractures in the Danish National Patient Registry between 2000 and 2018. A self-controlled case-series analysis and conditional Poisson regression were used to derive incidence rate ratios (IRR) of falls and fractures during six predefined periods.
In total 62,105 and 36,808 adults, respectively, experienced a fall or fracture. For older adults, the risk of falls was highest during the 3-month pre-treatment period (IRR , 4.22 (95% confidence interval, 3.53-5.05), IRR , 3.03 (2.59-3.55)) compared to the baseline (>1 year before initiation). The risk continued to be higher in the later treatment periods. Contrarily, in men and women aged 40-69 years, the risk was only higher in the 3-month pre-treatment period. The incidence of falls among young men and women was slightly lower after initiation of sedating medication (treatment period, IRR , 0.66 (0.50-0.86), IRR , 0.65 (0.51-0.83)). Analyses with fractures as outcome yielded similar results.
Although falls and fractures occur more often in persons using sedative-hypnotic medication, the higher risk of falls and fractures in the pre-treatment period relative to the period directly after treatment, suggests that this association is better explained by other factors that elicited the prescription of this medication rather than the adverse effects of the sedative-hypnotic medication.
评估使用苯二氮䓬类药物、Z 类药物或褪黑素的用户发生跌倒和骨折的风险。
我们随访了 2003 年至 2016 年期间在丹麦国家处方登记处购买苯二氮䓬类药物、Z 类药物或褪黑素的 699335 名成年人，随访其在 2000 年至 2018 年期间在丹麦国家患者登记处的跌倒和骨折情况。采用自我对照病例系列分析和条件泊松回归来得出六个预设时间段内跌倒和骨折的发病率比值（IRR）。
共有 62105 名和 36808 名成年人分别经历了跌倒或骨折。对于老年人，与基线期（起始治疗前>1 年）相比，治疗前 3 个月（IRR，4.22（95%置信区间，3.53-5.05），IRR，3.03（2.59-3.55））的跌倒风险最高。在后续治疗期间，风险仍持续升高。相反，在 40-69 岁的男性和女性中，仅在治疗前 3 个月风险较高。在开始使用镇静药物后，年轻男性和女性的跌倒发生率略有下降（治疗期 IRR，0.66（0.50-0.86），IRR，0.65（0.51-0.83））。作为结局的骨折分析得出了类似的结果。
尽管使用镇静催眠药物的患者跌倒和骨折的发生率更高，但与治疗后直接时期相比，治疗前时期发生跌倒和骨折的风险更高，这表明这种关联更好地解释为引发该药物处方的其他因素，而不是镇静催眠药物的不良反应。
