Figure 1Process 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.
Figure 2Definition of hazard and control periods.
Figure 3Control of study period. 1Subjects should have more than one hypnotic prescription and no stroke history within this 180 days.
Table 1.Baseline characteristics of study patients (n=1508)
Characteristics |
n (%) |
Gender |
|
Male |
302 (20.0) |
Female |
1206 (80.0) |
Age (yr) |
|
65-69 |
302 (20.0) |
70-74 |
407 (27.0) |
75-79 |
411 (27.3) |
80-84 |
253 (16.8) |
Over 85 |
135 (9.0) |
Comorbidity before fracture |
|
Hypertension |
763 (50.6) |
Osteoarthritis |
627 (41.6) |
Osteoporosis |
469 (31.1) |
Diabetes mellitus |
432 (28.6) |
Anemia |
326 (21.6) |
Depression |
242 (16.0) |
Dementia |
147 (9.7) |
Stroke |
134 (8.9) |
Rheumatoid arthritis |
82 (5.4) |
Heart failure |
80 (5.3) |
Visual disturbance |
41 (2.7) |
Parkinson’s disease |
33 (2.2) |
Table 2.Risk of fractures from hypnotic use in elderly insomnia patients stratified with a generic subgroup
Hypnotics |
No. of hazard period expo- sures (n = 1508) |
No. of control period expo- sures (n = 6032) |
Crude OR (95% CI) |
Adjusted OR1 (95% CI) |
Zolpidem |
236 |
722 |
1.84 (1.47, 2.30) |
1.72 (1.37, 2.16) |
Benzodiazepin hypnotics |
364 |
1394 |
1.12 (0.93, 1.34) |
1.00 (0.83, 1.21) |
Triazolam |
203 |
765 |
1.15 (0.91, 1.47) |
1.04 (0.82, 1.33) |
Lorazepam |
146 |
550 |
1.17 (0.87, 1.58) |
1.06 (0.79, 1.44) |
Flurazepam |
23 |
101 |
0.85 (0.48, 1.54) |
0.73 (0.41, 1.31) |
Flunitrazepam |
25 |
108 |
0.81 (0.40, 1.66) |
0.78 (0.38, 1.58) |
Midazolam |
3 |
15 |
0.69 (0.15, 3.30) |
0.60 (0.12, 2.92) |
Brotizolam |
7 |
27 |
1.07 (0.35, 3.31) |
0.97 (0.31, 2.97) |
Table 3.Risk of fractures from hypnotic use in elderly insomnia patients stratified by age group and gender
|
n |
Zolpidem exposure (n = 431)
|
Benzodiazepine exposure (n = 703)
|
|
n (%) |
OR (95% CI) |
n (%) |
OR (95% CI) |
Age (y) |
|
|
|
|
|
65-69 |
302 |
87 (9.4) |
1.90 (1.17, 3.11) |
122 (13.2) |
0.96 (0.61, 1.51) |
70-74 |
407 |
118 (10.5) |
1.69 (1.10, 2.59) |
194 (17.2) |
1.34 (0.95, 1.87) |
75-79 |
411 |
116 (10.2) |
1.56 (1.00, 2.45) |
190 (16.7) |
1.00 (0.70, 1.44) |
80-84 |
253 |
76 (9.0) |
1.69 (1.00, 2.86) |
130 (15.4) |
1.11 (0.72, 1.72) |
Over 85 |
135 |
34 (5.6) |
4.48 (2.00, 10.04) |
67 (11.1) |
1.13 (0.64, 2.01) |
Gender |
|
|
|
|
|
Male |
302 |
99 (9.7) |
1.74 (1.09, 2.77) |
135 (13.2) |
1.52 (0.97, 2.32) |
Female |
1206 |
332 (9.2) |
1.87 (1.45, 2.41) |
568 (15.7) |
1.09 (0.80, 1.49) |