Tuesday June 26, 2001 

Even Low-Dose Tranquilizers Up Hip Fracture Risk

NEW YORK (Reuters Health) - Even low dose or short-acting 
tranquilizers 
commonly prescribed to the elderly to treat insomnia or agitation 
can 
increase the risk of hip fracture, researchers report.

Overall, the use of benzodiazepines--a class of drug that includes 
diazepam (Valium) and alprazolam (Xanax)--accounts for about 5% of 
hip 
fractures among elderly individuals, a risk similar to that posed by 
the 
use of antipsychotic drugs and antidepressants.

Although the elderly make up only 13% of the population, they are 
given 
50% of all prescriptions for benzodiazepines, according to the report 
in 
the June issue of the American Journal of Psychiatry, Past studies 
have 
shown that the use of benzodiazepines increases the risk of hip 
fracture 
in the elderly, but it was unclear if certain doses or lengths of 
treatment were riskier than others, according to Dr. Philip Wang and 
associates at Brigham and Women's Hospital in Boston, 
Massachusetts.

In the new study, the researchers looked at more than 1,000 elderly 
patients with a broken hip and compared them with nearly 5,000 
people the 
same age who did not break a hip.

They found that all doses of benzodiazepines equal to 3 milligrams 
per 
day or more of diazepam increased the hip fracture risk by at least 
50%. 
These dose levels include the recommended treatment level (5 
milligrams a 
day) in prescription guidelines for elderly patients.

The risk for fracture was highest in the first two weeks after a 
patient 
starting taking the drug and after they had been taking the drug for 
more 
than a month.

Somewhat surprisingly, short-acting benzodiazepines were every bit 
as 
hazardous as long-acting benzodiazepines were, the results indicate.

The authors conclude that patients and their doctors should 
''exercise 
caution with all benzodiazepines and not be falsely assured that 
choosing 
agents with particular durations of action, without regard to other 
important features such as dosage and duration of use, will protect 
patients from potential adverse effects.''

However, in some patients the benefits of the drugs may still 
outweigh 
the risks, they note, and other drugs may not necessarily be any 
better 
at reducing the risk of breaking a hip. Some elderly patients may 
have 
severe enough problems with anxiety, agitation or insomnia that the 
drugs 
are warranted, they conclude.

SOURCE: American Journal of Psychiatry 2001;158:892-898