Age, Sex, and Dose Effects of Nonbenzodiazepine Hypnotics on Hip Fracture in Nursing Home Residents.

The study used Medicare claims and nursing home assessments, so it could not confirm that residents actually swallowed the hypnotic; it used drug possession as a proxy. The reason for hypnotic use was not recorded, and non-prescription products such as melatonin were not visible in the claims data. Time-varying confounding could remain, such as other drugs or changes in health status, although a prior sensitivity analysis suggested antidepressant confounding alone was unlikely to explain the result. The age and dose subgroup differences had overlapping confidence intervals, so they are not firmly established. The data were from 2007 to 2008, before the 2013 FDA dose warning and the 2015 Beers update. The analysis could not compare nightly use with intermittent use. Only residents who had a hip fracture were included, so the study estimates relative exposure risk, not absolute fracture rates in all nursing home residents.

The supplied text does not include author conflict-of-interest statements. The publication types indicate research support from NIH extramural and U.S. government Public Health Service.

Do not conclude that these hypnotics caused hip fracture or that older age and high dose were proven to increase risk beyond chance. The study is observational, exposure was drug possession rather than confirmed use, and the age and dose confidence intervals overlapped.