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Sleep aids tied to hip fractures in the elderly

By Genevra Pittman

NEW YORK (Reuters Health) - Nursing home residents taking sleep aids such as Ambien are more likely to fall and fracture a hip than residents not being treated for insomnia, new research suggests.

According to the study's lead author, the known dangers of older benzodiazepine sedatives, such as Valium and Xanax, among elderly patients have led many doctors to turn to the newer medicines, known as non-benzodiazepines, but that doesn't mean they're any safer.

Benzodiazepines are associated with an increased risk of falls and fractures, said Dr. Sarah Berry, from Hebrew SeniorLife and Harvard Medical School in Boston. "But there's been less research on some of these newer sleep drugs," she told Reuters Health.

The studies that have been done show non-benzodiazepines can impair balance, memory and driving ability, Berry added.

She and her colleagues analyzed the medical records of more than 15,000 U.S. nursing home residents who suffered a hip fracture in 2007-2008. Of them, 11 percent had been prescribed a non-benzodiazepine hypnotic drug - such as Ambien, Lunesta or Sonata - before their fracture.

Comparing patients' medication use in the few weeks before their injury to months earlier, the researchers calculated that taking a non-benzodiazepine was tied to a 66-percent increase in the risk of fracture.

Newer users who'd been on sleep aids for less than two months were more than twice as likely to fracture their hip, compared to people not currently using the drugs, the team reported Monday in JAMA Internal Medicine.

A Dutch study from earlier this year found that seniors taking psychiatric drugs including hypnotics were at higher risk of falling - the cause of most hip fractures (see Reuters Health story of February 8, 2013 here: http://reut.rs/XXi0YY).

Hip fractures account for more than 320,000 hospital admissions every year in the U.S. and are a major source of disability among seniors.

"As with any medicine - including those prescribed to treat sleeping disorders - physicians and patients should discuss the appropriate use, potential benefits and side effects based on information and data to date," a representative from Sanofi, which markets Ambien, told Reuters Health in an email.

"Sanofi stands behind the robust clinical data that have demonstrated the safety and efficacy of Ambien since its approval in the U.S. in 1992, representing more than 20 years of real-world use and 22 billion nights of patient therapy worldwide," he added.

Insomnia is common in nursing homes - and can itself lead to falls and fractures, the researchers pointed out. Berry recommended doctors try to treat elderly insomniacs without drugs whenever possible and keep an extra close eye on those who do need medication, especially people who are mobile enough to get themselves in trouble.

"Clearly not sleeping is a problem, but if we can address it without a drug then I think it's safer for the patient," she said. Non-drug strategies to treat insomnia include encouraging nursing home residents to be more active and avoid napping during the day, she added.

Dr. Eric Widera, a geriatrician from the University of California, San Francisco, who wrote a commentary published with the study, said doctors should question what might be causing a resident's insomnia - rather than just prescribing a drug.

Even simple things like a roommate's late-night TV watching or other sources of background noise may be to blame, he told Reuters Health.

"It's not enough to stop these medications, we also have to introduce alternatives… to prevent and treat sleeping disorders in this very frail population," Widera said.

SOURCE: http://bit.ly/Zg6fw5 JAMA Internal Medicine, online March 4, 2013.

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