{"id":1677,"date":"2018-04-10T22:01:41","date_gmt":"2018-04-10T22:01:41","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/?p=1677"},"modified":"2018-04-27T10:06:09","modified_gmt":"2018-04-27T10:06:09","slug":"falls-and-fractures-with-z-drugs","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/04\/10\/falls-and-fractures-with-z-drugs\/","title":{"rendered":"Falls and fractures with Z drugs\u00a0"},"content":{"rendered":"<p>&nbsp;<\/p>\n<p><em>Z-drugs might be associated with an increased risk of fractures, falls, and injuries and their use should be considered in the context of overall risk of falls in an individual<\/em><\/p>\n<p style=\"text-align: right\">Carl Heneghan<\/p>\n<hr \/>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-thumbnail wp-image-1324 alignleft\" src=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2017\/06\/Carl-Heneghan-150x150.png\" alt=\"\" width=\"150\" height=\"150\" \/>Zolpidem, zopiclone, eszopiclone and zaleplon, are known as the \u2018Z-drugs\u2019. They even have their own <a href=\"https:\/\/en.wikipedia.org\/wiki\/Z-drug\">Wikipedia<\/a> page. \u00a0They are a group of drugs with effects similar to\u00a0<a href=\"https:\/\/en.wikipedia.org\/wiki\/Benzodiazepines\">benzodiazepines<\/a>, used to\u00a0treat insomnia and are thought to have several advantages over benzodiazepines.<\/p>\n<p>A recent <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29077902\">systematic review<\/a> evaluated the association between Z-drugs and falls and fractures. \u00a0\u00a0The review identified 14 studies (9 case-control, 5 cohorts), and reported Z-Drugs were associated with a significant increase in fractures, (OR = 1.63; 95% CI: 1.42-1.87). However, there was considerable heterogeneity (I2 = 90%). The association remained with the removal of the three studies contributing to the heterogeneity (OR = 1.52, 95% CI: 1.39\u20131.66).<\/p>\n<p>The effect was further reduced in a subgroup analysis of studies that included control groups diagnosed with insomnia (OR = 1.28, 95% CI: 1.08\u20131.53) and was moderated when the lower quality studies were removed (OR = 1.40, 95% CI 1.07\u20131.84). The effect on falls was less clear, and data on injuries was available only for zolpidem (OR = 2.05, CI 95%: 1.95\u20132.15,\u00a0<em>I<\/em><sup>2<\/sup>\u00a0= 0).<\/p>\n<p>The quality of the evidence limits the interpretation of these results. Much of the effect can be explained by systematic differences in the selection of the cases and control groups within the studies. \u00a0<a href=\"https:\/\/catalogofbias.org\/biases\/selection-bias\/\">Selection bias<\/a> can occur when individuals or groups in a study differ systematically from the population of interest. Despite these\u00a0limitations, this evidence should\u00a0be noted in the context of the overall risk of falls in an individual.<\/p>\n<p><strong>References <\/strong><\/p>\n<p>Treves N., Perlman A., Geron L.K., Asaly A., &amp; Matok I. (2018). Z-drugs and risk for falls and fractures in older adults-a systematic review and meta-analysis. <em>Age and Ageing<\/em>, <em>47<\/em>(2), 201\u2013208.<\/p>\n<p>Catalogue of Bias Collaboration, Nunan D, Bankhead C, Aronson JK. Selection bias. Catalogue Of Bias 2017: http:\/\/www.catalogofbias.org\/biases\/selection-bias\/<\/p>\n<hr \/>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1618 alignright\" src=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/01\/Picture1-2-1.png\" alt=\"\" width=\"380\" height=\"203\" srcset=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/01\/Picture1-2-1.png 380w, https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2018\/01\/Picture1-2-1-300x160.png 300w\" sizes=\"auto, (max-width: 380px) 100vw, 380px\" \/><\/p>\n<p>BMJ\u00a0<a href=\"http:\/\/ebm.bmj.com\/\">Evidence-Based Medicine<\/a>\u00a0\u2013\u00a0original evidence-based research, insights and opinions on what matters for health care.<\/p>\n<p>&nbsp;<\/p>\n<hr \/>\n<p>Carl Heneghan is<a href=\"http:\/\/www.phc.ox.ac.uk\/team\/researchers\/carl-heneghan\">\u00a0Professor of EBM<\/a>\u00a0at the University of Oxford,<a href=\"http:\/\/www.cebm.net\/\">\u00a0Director of CEBM<\/a>\u00a0and Editor in Chief of BMJ <a href=\"http:\/\/ebm.bmj.com\/\">Evidence-Based Medicine<\/a><\/p>\n<p><em>Follow on twitter\u00a0<a href=\"https:\/\/twitter.com\/carlheneghan?lang=en\">@carlheneghan<\/a><\/em><\/p>\n<p><b>Competing interests<\/b><\/p>\n<p>Carl has received expenses and fees for his media work including BBC Inside Health. He holds grant funding from the NIHR, the NIHR School of Primary Care Research, The NIHR Oxford BRC\u00a0 and the WHO. He has also received income from the publication of a series of toolkit books published by Blackwells. CEBM jointly runs the\u00a0<a title=\"\" href=\"http:\/\/evidencelive.org\/\">EvidenceLive<\/a>\u00a0Conference with the BMJ and the\u00a0<a title=\"\" href=\"http:\/\/www.preventingoverdiagnosis.net\/\">Overdiagnosis Conference<\/a>\u00a0with some international partners which are based on a\u00a0 non-profit model.<strong>\u00a0<\/strong><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; Z-drugs might be associated with an increased risk of fractures, falls, and injuries and their use should be considered in the context of overall risk of falls in an individual Carl Heneghan Zolpidem, zopiclone, eszopiclone and zaleplon, are known as the \u2018Z-drugs\u2019. They even have their own Wikipedia page. \u00a0They are a group of [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/04\/10\/falls-and-fractures-with-z-drugs\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":783,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14374,14388],"tags":[],"class_list":["post-1677","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-carl-heneghan","category-evidence-watch"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Falls and fractures with Z drugs\u00a0 - BMJ EBM Spotlight<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/04\/10\/falls-and-fractures-with-z-drugs\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Falls and fractures with Z drugs\u00a0 - BMJ EBM Spotlight\" \/>\n<meta property=\"og:description\" content=\"&nbsp; Z-drugs might be associated with an increased risk of fractures, falls, and injuries and their use should be considered in the context of overall risk of falls in an individual Carl Heneghan Zolpidem, zopiclone, eszopiclone and zaleplon, are known as the \u2018Z-drugs\u2019. 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