PSYCHOTROPICS, THIAZIDE DIURETICS AND HIP-FRACTURES IN THE ELDERLY

Objective: To determine whether psychotropic medications increase, and thiazide diuretics decrease, the risk of hip fractures in elderly Australians. Design: Population-based case-control study. Subjects and Setting: The population aged 65 years and over living in a defined area in western Sydney, Australia, during 1990-1991. Cases (n=209) were recruited from hospitals and controls (n=207) were selected by an area probability sampling method, with additional sampling from nursing homes. Response rates were 96% for cases and 84% for controls. Measures: Data were collected directly from subjects by questionnaire; a proxy respondent was required for 27% of subjects. In addition to medication use, information was also collected on potential confounders: alcohol consumption, body mass index, cognitive status, dairy product consumption, health status, physical activity, smoking history and type of residence. Results: The use of temazepam, a short-acting benzodiazepine, was associated with an increase in the risk of hip fracture - odds ratio, adjusted for age, gender and residence is 3.78; 95% confidence interval (CI), 1.60-8.92. After adjusting for multiple potential confounders by logistic regression, the odds ratio for temazepam use was 3.52. There was a non-significant (P>0.05) increase in hip fracture risk associated with the use of antidepressants and antipsychotics. Thiazide diuretics were not associated with a risk of hip fracture - the multivariate-adjusted odds ratio was 0.98 (95% CI, 0.49-1.99). Conclusions: Temazepam may increase the risk of hip fracture in elderly people. The effect of thiazide diuretics on fracture risk should be assessed in a large randomised trial.