Sleep tablets ‘double risk of hip breaks in the elderly’

PENSIONErS who take sleeping pills popular with millions could double their risk of breaking a hip in falls.

More than a quarter of Britons have taken the common hypnotics benzodiazepines and so-called z-drugs.

But researchers have found the elderly are two and a half times more likely to suffer a fracture in their first fortnight on the tablets.

Their review of 219 studies warns that sleeping pills put over-65s at risk by causing daytime drowsiness, delayed reaction times and impaired balance.

Dr Ben Carter, a co-author of the study by Cardiff University and the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, said: ‘While zdrugs are fast becoming the doctor’s hypnotic prescription of choice, there is no evidence that they are a safer alternative to benzodiazepines in relation to hip fracture risk.

‘Our study shows that both appear to significantly increase the risk of hip fracture when newly prescribed by doctors.’

The paper, published in the journal PLOS ONE, concludes that doctors should consider the increased risk of falling when prescribing sleeping pills to the elderly. It follows warnings in 2013 that z-drugs, which include the brands Zolpidem, Zaleplon and Zopiclone, increased the risk of heart attacks by up to 50 per cent.

Despite the risks, an estimated one in ten people in Britain regularly use some kind of sleeping tablet – with pensioners most likely to suffer disturbed sleep.

The latest research found a hip fracture rate 2.5 times higher for those over65 taking benzodiazepines and z-drugs in the first fortnight, when they are not used to the medication.

This age group are still 53 per cent more likely to fall and break their hip up to a month after starting the sleeping tablets compared to those not taking them. The figure is 20 per cent in longterm users. The risk comes from the way in which sleeping pills work, inducing drowsiness by slowing down the brain after binding to a neurotransmitter that controls mood and mental awareness.

This can create a ‘hangover effect’ the following day, reducing alertness and raising the chance of a fall.

Hip fractures pose a particular danger to the elderly, with reports showing that a third of older people die within a year of such injuries.

The total annual toll is predicted to reach 4.5 million in Europe by 2025.

Although the elderly are most in danger, scientists say even those in their 50s and early 60s could be affected.

The study is likely to add to concerns because broken bones in the elderly are a major problem for the NHS as the population ages. The health service already spends £4.6million a day treating fractures caused by falls. Hip fractures alone cost hospitals over £1billion a year.

Dr Carter said: ‘Careful consideration of the immediate increased risk of hip fracture should inform the clinical decision-making process. Clinically effective measures like strength training to improve frailty, removal of hazards at home, visual correction and a medication review are also needed to mitigate the risk of hip fractures, particularly in the first few days of use.’

Z-drugs have become more popular than benzodiazepines, as they are believed to be less addictive and have fewer side-effects. But researchers found they created a similar hip fracture risk.

It follows a study by Keele University last year which found those who took zdrugs were twice as likely to break a bone, including wrists, arms and legs.

Scientists trawled through patient records from over 300 GP surgeries and identified nearly 3,500 people aged over 45 who were prescribed sleeping tablets for insomnia. Melatonin, often touted as a cure for jet lag, increased the risks of a fracture by 90 per cent. Most injury victims were in their mid-60s and had been on the drugs for about a year.

Last year, Finnish scientists found taking sleeping tablets at least twice a week trebled the risk of lung cancer.

‘Hangover effect the following day’