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Osteoporosis International
Published in: Osteoporosis International 10/2016

01-10-2016 | Original Article

Zolpidem use and risk of fractures: a systematic review and meta-analysis

Authors: S. M. Park, J. Ryu, D. R. Lee, D. Shin, J. M. Yun, J. Lee

Published in: Osteoporosis International | Issue 10/2016

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Abstract

Summary

Zolpidem is a representative of non-benzodiazepine hypnotics. Recent epidemiologic studies have reported increased fracture risk in patients taking zolpidem, but the results have been inconsistent. The present meta-analysis shows that the use of zolpidem is associated with an increased risk of fractures.

Purpose

Previous studies have reported inconsistent findings regarding the association between the use of zolpidem and the risk of fractures. We performed a systematic literature review and meta-analysis to assess the association.

Methods

We identified relevant studies by searching MEDLINE, EMBASE, Cochrane Library, and PsycINFO without language restrictions (until August 2014). Methodological quality was assessed based on the Newcastle-Ottawa Scale (NOS).

Results

A total of 1,092,925 participants (129,148 fracture cases) were included from 9 studies (4 cohort, 4 case-control, and 1 case-crossover study). Overall, the use of zolpidem was associated with an increased risk of fracture (relative risk [RR] 1.92, 95 % CI 1.65–2.24; I 2 = 50.9 %). High-quality subgroups (cohort studies, high NOS score, adjusted for any confounder, or adjusted for osteoporosis) had higher RRs than the corresponding low-quality subgroups (high quality, 1.94–2.76; low quality, 1.55–1.79). Of note, the risk for hip fracture was higher than that for fracture at any site (hip fracture, RR 2.80, 95 % CI 2.19–3.58; fracture at any site, RR 1.84, 95 % CI 1.67–2.03; P < 0.001).

Conclusions

The use of zolpidem may increase the risk of fractures. Clinicians should be cautious when prescribing zolpidem for patients at high risk of fracture.
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Metadata
Title
Zolpidem use and risk of fractures: a systematic review and meta-analysis
Authors
S. M. Park
J. Ryu
D. R. Lee
D. Shin
J. M. Yun
J. Lee
Publication date
01-10-2016
Publisher
Springer London
Published in
Osteoporosis International / Issue 10/2016
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-016-3605-8

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