Benzodiazepine use was not shown to be associated with hip fractures after all, according to a new study from the Department of Ambulatory Care and Prevention (of Harvard Medical School and Harvard Pilgrim Health Care). Previous epidemiological studies suggesting an association have been used to support legislation and policy decisions that limit access to these drugs among the elderly. These policies may need to be reexamined based on these new findings, which are being published in the Jan. 16 Annals of Internal Medicine.
Benzodiazepines are sedative drugs prescribed for anxiety, sleep, and seizure disorders. Concerns about abuse, misuse, and adverse effects of these drugs--including hip fractures among the elderly--have prompted state and national policies intended to regulate access to them. Since January 2006, benzodiazepines have been excluded from coverage through the Medicare Part D drug benefit.
Hip fractures are the most serious individual and public health risks attributed to benzodiazepines because they often lead to disability and death among the elderly. An expected benefit of limiting access to these drugs is a decrease in the incidence of falls and resulting hip fractures. However, no data exist to demonstrate this policy effect.
Anita Wagner, PharmD, MPH, DrPH, lead author of the study and assistant professor of ambulatory care and prevention in the Department of Ambulatory Care and Prevention (DACP) of Harvard Medical School and Harvard Pilgrim Health Care, and colleagues studied whether a state policy that drastically decreased use of benzodiazepines resulted in fewer hip fractures among the elderly. They looked for changes in hip fracture rates in a stable population of more than 90,000 Medicaid recipients age 65 and older before and after a policy was implemented in New York in 1989 requiring benzodiazepine prescribing on triplicate forms. Since then, all physicians in the state are required to obtain, pay for, and use serially-numbered triplicate forms to prescribe benzodiazepines. Pharmacists forward one copy of the prescription to state health authorities for surveillance, allowing for monitoring of each physician's prescribing, each pharmacy's dispensing, and each patient's receipt of benzodiazepines.
The policy resulted in an immediate 60 percent reduction in benzodiazepine use among women and 58 percent among men. The neighboring demographically-similar state New Jersey did not regulate benzodiazepine prescribing and benzodiazepine use did not change. Incidence of hip fracture before and after the policy change was similar.
"The policy drastically decreased use of benzodiazepines in New York and we did not see any decline in hip fracture rates compared to New Jersey; in fact, we seem to see an increase in New York over New Jersey," says Wagner.
There are several possible explanations for the study results. Most plausible, however, are biases in the previous studies that found a relationship between these drugs and hip fractures.
"It is very challenging to answer the question whether or not benzodiazepines cause hip fractures. People who get benzodiazepines, such as chronically ill elderly patients with dementia, have conditions, like dementia, that can cause hip fractures--and their hip fractures may not be due to their benzodiazepines," says Wagner.
"The challenge of disentangling the effects of benzodiazepines from other causes of hip fractures in the elderly is especially concerning when study results are used to guide policies that restrict access to medicines for huge populations," says senior author Stephen Soumerai, ScD, professor of ambulatory care and prevention at DACP.
Policy makers may expect that reducing access to benzodiazepines under Medicare Part D and other policies will decrease hip fracture risk. "Our study suggests that these expectations are not justified," says Soumerai.
Additionally, if benzodiazepine medications are abruptly terminated, as may be the case when people lose coverage of a drug, negative effects can occur, such as withdrawal reactions, seizures, emergency department visits, and hospital admissions. These may offset any potential savings achieved by limiting coverage of benzodiazepines.
The investigators are currently funded by a grant from the National Institute on Aging to monitor the impact of the Medicare Drug Benefit. They believe future studies based on these new data will shed additional light on how policies that exclude coverage for benzodiazepines affect the rate of hip fracture among the elderly.
Leah Gourley | EurekAlert!
Smart Data Transformation – Surfing the Big Wave
02.12.2016 | Fraunhofer-Institut für Angewandte Informationstechnik FIT
Climate change could outpace EPA Lake Champlain protections
18.11.2016 | University of Vermont
In recent years, lasers with ultrashort pulses (USP) down to the femtosecond range have become established on an industrial scale. They could advance some applications with the much-lauded “cold ablation” – if that meant they would then achieve more throughput. A new generation of process engineering that will address this issue in particular will be discussed at the “4th UKP Workshop – Ultrafast Laser Technology” in April 2017.
Even back in the 1990s, scientists were comparing materials processing with nanosecond, picosecond and femtosesecond pulses. The result was surprising:...
Have you ever wondered how you see the world? Vision is about photons of light, which are packets of energy, interacting with the atoms or molecules in what...
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.
The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...
16.11.2016 | Event News
01.11.2016 | Event News
14.10.2016 | Event News
07.12.2016 | Materials Sciences
07.12.2016 | Earth Sciences
07.12.2016 | Earth Sciences