The global consumption of sedative-hypnotic medications is on the rise, particularly in affluent regions like Hong Kong.
Researchers at the University of Hong Kong (HKUMed) conducted a comprehensive study involving more than 6 million individuals across 11 countries and regions to see the connection between specific sedative-hypnotics and the risk of bone fractures.
Their findings show that the use of certain sedative-hypnotic medications is moderately associated with an increased risk of bone fractures, estimated to be between 30% to 40%.
This study underscores the importance of carefully evaluating the benefits and risks associated with prescribing sedative-hypnotics, particularly for patients at a high risk of bone fractures. The results of this research have been published in Sleep Medicine Reviews.
Sedative-hypnotics are drugs commonly used to alleviate anxiety, tension, and improve sleep quality. They fall into three generations: barbiturates and chloral hydrate, benzodiazepines (BZD), and z-drugs.
Previous studies have hinted at a potential risk of bone fractures associated with the use of sedative-hypnotics. This risk may be attributed to side effects of these medications, such as dizziness, drowsiness, and low blood pressure, which can increase the likelihood of falls and subsequent injuries.
However, the existing evidence has been inconclusive, likely due to the complex mechanisms involved and the multitude of factors contributing to fractures.
To address this gap in knowledge, researchers at CSMPR conducted a systematic review and meta-analysis to consolidate existing evidence and determine the association between sedative-hypnotic use and the risk of fractures.
The research team examined 20 observational studies conducted in 11 countries and regions, involving over 6 million individuals.
These included six cohort studies, eight case-control studies, and six case-crossover studies, with one also incorporating a self-controlled case series design. Eleven of these studies were incorporated into a subsequent meta-analysis.
All the studies were rated as high quality, receiving scores ranging from 7 to 9 out of 10 stars according to the Newcastle-Ottawa Scale, a widely accepted tool for assessing study quality.
The review uncovered that 18 out of the 20 studies revealed a significant association between the use of sedative-hypnotic medications and an increased risk of fractures.
The meta-analysis estimated that sedative-hypnotic users have a 30% higher risk of fractures compared to non-users.
Specifically, the pooled analysis showed that the use of BZD was associated with a 32% higher risk of hip fractures, while the use of z-drugs was linked to a 41% higher risk of fractures at any site in the body. The risk was similar for both long-acting and short-acting sedative-hypnotics.
Despite certain limitations, such as unmeasured confounding effects, this study highlights the potential but rare side effects of fractures associated with the use of sedative-hypnotic medications.
Further research is needed to explore the underlying causes of this elevated fracture risk, but falls are likely to contribute significantly to this association.
The study recommends that patients at a higher risk of fractures, such as those aged 85 years or above or living alone, should be prescribed sedative-hypnotics with caution.
Patients should receive appropriate counseling before being prescribed these medications, and healthcare providers should monitor and mitigate the risk of falls and fractures among sedative-hypnotic users.
Preventive measures to reduce the risk of falls can also be crucial in minimizing the risk of fractures.
Dr. Francisco Lai Tsz-tsun, an assistant professor at HKUMed and the senior author of the study, emphasizes the need for a more thorough clinical assessment of patients based on the overall safety profile of specific sedative-hypnotic agents before prescribing them, given the increasing global use of these medications, including off-label usage.
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The research findings can be found in Sleep Medicine Reviews.
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