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‘Z-drugs’ leave dementia patients at a higher risk of bone fractures


Dementia patients taking prescribed sleeping drugs, commonly known as “Z-drugs”, are at a higher risk of experiencing bone fractures, according to UK researchers.

They highlighted that the non-benzodiazepine hypnotic pills zolpidem, zopiclone and zaleplon were commonly prescribed to help patients suffering from insomnia.

“We desperately need better alternatives to the drugs currently being prescribed for sleep problems”

Chris Fox

Around half of people with dementia have trouble sleeping, wake often and wander during the night, noted the researchers.

However, their new study has found that Z-drug use is associated with a 40% increased risk of any type of fracture, with higher doses leading to higher risks.

It also found that Z-drug use was associated with an increased risk in mortality, a consequence of fractures, specifically hip fractures.

Other hypothesized effects such as infections, stroke or worsening cognitive function was not found to link with usage.

Though a higher risk of falls was not directly found, the researchers said this could be due to how adverse effects were recorded.

Funded by the National Institute for Health Research, the study compared the data of 2,952 people with dementia who were newly prescribed Z-drugs with data from 1,651 who were not.

“This compelling evidence base helped persuade everyone involved in the field to take action”

Clive Ballard

Lead researcher Professor Chris Fox, from the University of East Anglia, said: “Fractures in people with dementia can have a devastating impact, including loss of mobility, increased dependency, and death.

“We desperately need better alternatives to the drugs currently being prescribed for sleep problems and other non-cognitive symptoms of dementia,” he said.

“Fractures often happen as a result of falls,” he said. “However, if an elderly person falls and fractures a bone, it would be recorded simply as a fracture rather than a fall.

“Wherever possible, we recommend that people with dementia avoid using Z-drugs if their sleep disturbance can be managed in other ways,” said Professor Fox.

Non-pharmacological alternatives should be considered and when Z-drugs were prescribed patients should receive care that reduces or prevents the occurrence of falls,” he added.

Study author Dr Ian Maidment, from Aston University, presented the research this week at the Alzheimer’s Association International Conference in Chicago.

He said that non-medication methods including regular exercise and a person-centred approach to sleep should be used first line. “If a z-drug is prescribed it should be regularly reviewed and stopped as soon as possible,” he said.

Commenting on the research, Professor Clive Ballard, from the University of Exeter, highlighted that previous studies on antipsychotics had shown they increased harmful side effects and death rates in people with dementia.

“This compelling evidence base helped persuade everyone involved in the field to take action, from policy makers to clinicians, reducing prescribing by 50%,” he said.

University of Exeter

New drug may provide relief from psychosis in dementia

Clive Ballard

He added: “We now urgently need a similar concerted approach to Z-drugs, to protect frail elderly people with dementia from fractures and increased risk of death.”

Researchers from Exeter, King’s College London and the University of Bergen also presented two studies at the same conference in the US this week, which looked at opioid-based painkillers and dementia.

In a trial of 162 Norwegian care home residents, the team found a significant rise in side effect from the drugs, such as personality changes, confusion and sedation.

Meanwhile, their second study, involving mice, suggested people with dementia were more susceptible to opioid-based painkillers, because they over-produced the body’s natural opioids.


Readers' comments (3)

  • Very interesting article. I've shared this with our Admiral Nurse, as we're doing some work around dementia & falls currently. Thank you.

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  • I have also found this interesting and will pass on to my colleagues in dementia care and assessment.

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  • Any research on Melatonin? It is a naturally occuring "sleep hormone"is it not?

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