New Users of Drugs to Treat Insomnia at Increased Risk of Hip Fracture

    Older people have a significantly greater risk of sustaining a hip fracture in the first 2 weeks of taking drugs to treat insomnia, such as benzodiazepines or the so-called Z-drugs, than non-users, according to a new study by researchers at Cardiff University and King’s College London.

    The study was published online by PLOS ONE.

    “While Z-drugs are fast becoming the doctor’s hypnotic prescription of choice, there is no evidence that they are a safer alternative to benzodiazepines in relation to hip fracture risk,” said senior study author Dr. Ben Carter explained.

    “Our study shows that both appear to significantly increase the risk of hip fracture when newly prescribed by doctors.”

    The Z-drugs are zolpidem, zaleplon, and zopiclone, which are classified as non-benzodiazepine hypnotics.

    The study included patients age 65 and older who were new users of these hypnotic medicines. They experienced nearly 2.5 times the fracture rate compared with older people not taking hypnotics. An estimated 53% increase in fracture risk was identified in medium-term users (15 to 30 days), as well as a 20% increased risk of hip fracture in long-term users (greater than 30 days).

    “Careful consideration of the immediate increased risk of hip fracture should inform the clinical decision-making process,” Dr. Carter said. “Clinically effective measures like strength training to improve frailty, removal of hazards at home, visual correction, and a medication review are also needed to mitigate the risk of hip fractures, particularly in the first few days of use.”

    The research supports previous studies linking use of hypnotics by older people with an increased risk of accidents, dependence, cognitive decline, and hip fracture. The drugs are also thought to cause drowsiness, delayed reaction times, and impaired balance.


    Donnelly K, Bracchi R, Hewitt J, Routledge PA, Carter B. Benzodiazepines, Z-drugs and the risk of hip fracture: a systematic review and meta-analysis. PLOS ONE. Published: April 27, 2017. https://doi.org/10.1371/journal.pone.0174730