Excess Risk for Hip Fracture Among Nursing Home Residents Who Take Nonbenzodiazepine Hypnotics

The lack of Medicare Part D coverage of benzodiazepines (BZDs) because of hip-fracture concerns effectively has eliminated their use in nursing homes, because most nursing home medication coverage comes from Part D. The result is increased use of non-BZD hypnotics, such as zolpidem (Ambien and generics), eszopiclone (Lunesta), and zaleplon (Sonata and generics). Case-control studies suggest that these hypnotics also carry risk for hip fracture, but unmeasured risk factors might have influenced these findings. Because a randomized controlled trial is not appropriate, investigators designed a self-controlled, case-crossover study: Exposure to these drugs during the month just prior to hip fracture was compared with drug exposure during two ea…