Psychotropic drug use, falls and hip fracture in the elderly

The use of benzodiazepines (BZD) or other psychotropic agents is an establi shed risk factor for falls and hip fractures. The evidence supporting this association has been based solely on history and/or prescription data. In a case-control study we monitored the intake of BZD, tricyclic antidepressan ts (TCA) and barbiturates in patients with hip fracture by serum analysis, and compared this measurement with drug history and prescription records. T he serum was BZD positive in 41% of 82 community-dwelling patients; an equi valent by history and/or prescription records, however, was detected in onl y 18% (p < 0.0001). In contrast, in 82 age- and gender-matched community-dw elling control patients, there was only a minor discrepancy (3%) in BZD use between anamnestic (N = 19) and analytical (N = 21) data. In 23 patients a dmitted from nursing homes, a similar trend was visible (39% serum positive for BZD vs 26% by drug history). Barbiturate use (N = 2) could be neglecte d, and TCA intake was minor(N = 7); in each case both assessments were in a ccordance. In conclusion, in patients with hip fracture, BZD use is substan tially more frequent than reported and previously assumed, pointing to an u nderestimated risk factor for this injury. (C) 2000, Editrice Kurtis.