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Zolpidem use and risk of fracture in elderly insomnia patients.

Kang DY, Park S, Rhee CW, Kim YJ, Choi NK, Lee J, Park BJ - J Prev Med Public Health (2012)

Bottom Line: Time independent confounding factors such as age, gender, lifestyle, cognitive function level, mobility, socioeconomic status, residential environment, and comorbidity could be controlled using the case-crossover design.Time dependent confounding factors, especially co-medication of patients during the study period, were adjusted by conditional logistic regression analysis.Likewise, the results were not statistically significant in stratified analysis with each benzodiazepine generic subgroup.

View Article: PubMed Central - PubMed

Affiliation: Department of Preventive Medicine, Seoul National University College of Medicine, Korea.

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 case-crossover 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.

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Related in: MedlinePlus

Process for selecting study subjects. HIRA, Health Insurance Review and Assessment Service; ICD-10, International Statistical Classification of Diseases and Related Health Problems, 10th revision; ER, Emergency room; OS, orthopedics.
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Figure 1: Process for selecting study subjects. HIRA, Health Insurance Review and Assessment Service; ICD-10, International Statistical Classification of Diseases and Related Health Problems, 10th revision; ER, Emergency room; OS, orthopedics.

Mentions: This study targeted elderly insomnia patients who visited medical clinics anywhere in South Korea for fracture as the main diagnosis from July 1, 2005 to June 30, 2006. The targeted age for the elderly was 65 years and older at the time the fracture occurred. Insomnia patients are defined as patients who were mainly or partly diagnosed with insomnia (ICD-10: F510, G470) and who were prescribed sleeping pills more than once. Among these patients, our main research targets were people who were diagnosed with fracture (ICD-10: S02, S12, S22, S32, S42, S52, S62, S72, S82, S92, T02) and visited the emergency room or were treated with orthopedics. And the first day the patient was examined was defined as the day that fracture occurred. Once fracture occurred, when a traffic accident followed (ICD-10: V00-09) or when stroke (ICD-10: 160-64) occurred during the 180 days prior to the fracture of an individual patient, then that patient was excluded from the research sample (Figure 1).


Zolpidem use and risk of fracture in elderly insomnia patients.

Kang DY, Park S, Rhee CW, Kim YJ, Choi NK, Lee J, Park BJ - J Prev Med Public Health (2012)

Process for selecting study subjects. HIRA, Health Insurance Review and Assessment Service; ICD-10, International Statistical Classification of Diseases and Related Health Problems, 10th revision; ER, Emergency room; OS, orthopedics.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3412984&req=5

Figure 1: Process for selecting study subjects. HIRA, Health Insurance Review and Assessment Service; ICD-10, International Statistical Classification of Diseases and Related Health Problems, 10th revision; ER, Emergency room; OS, orthopedics.
Mentions: This study targeted elderly insomnia patients who visited medical clinics anywhere in South Korea for fracture as the main diagnosis from July 1, 2005 to June 30, 2006. The targeted age for the elderly was 65 years and older at the time the fracture occurred. Insomnia patients are defined as patients who were mainly or partly diagnosed with insomnia (ICD-10: F510, G470) and who were prescribed sleeping pills more than once. Among these patients, our main research targets were people who were diagnosed with fracture (ICD-10: S02, S12, S22, S32, S42, S52, S62, S72, S82, S92, T02) and visited the emergency room or were treated with orthopedics. And the first day the patient was examined was defined as the day that fracture occurred. Once fracture occurred, when a traffic accident followed (ICD-10: V00-09) or when stroke (ICD-10: 160-64) occurred during the 180 days prior to the fracture of an individual patient, then that patient was excluded from the research sample (Figure 1).

Bottom Line: Time independent confounding factors such as age, gender, lifestyle, cognitive function level, mobility, socioeconomic status, residential environment, and comorbidity could be controlled using the case-crossover design.Time dependent confounding factors, especially co-medication of patients during the study period, were adjusted by conditional logistic regression analysis.Likewise, the results were not statistically significant in stratified analysis with each benzodiazepine generic subgroup.

View Article: PubMed Central - PubMed

Affiliation: Department of Preventive Medicine, Seoul National University College of Medicine, Korea.

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 case-crossover 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.

Show MeSH
Related in: MedlinePlus