The Journal of the American Geriatric Society has featured a retrospective cohort study to determine whether zolpidem is a safer alternative to benzodiazepines.

The community based study involved patients with an initial prescription for zolpidem (n = 43,343), alprazolam (n = 103,790), lorazepam (n = 150,858), or diazepam (n = 93,618), and rates of non-vertebral fractures and hip fractures requiring hospitalisation were compared before and after an initial prescription for each treatment, adjusting for confounders.

The following results were reported:
• In patients aged 65 and older, the rates of non-vertebral fractures and dislocations were similar in the pre- treatment intervals.
• The rate ratios (RRs) for the 90-day post-treatment interval relative to the pretreatment interval were 2.55 (95% confidence interval (CI) = 1.78–3.65; P < 0.001) for zolpidem, 1.14 (95% CI = 0.80–1.64; P = 0.42) for alprazolam, 1.53 (95% CI = 1.23–1.91; P < 0.001) for lorazepam, and 1.97 (95% CI = 1.22–3.18; P = 0.01) for diazepam.
• The ratio of RRs (RRR) (the RR in the posttreatment period adjusted for the corresponding RR in the pretreatment period) were 2.23 (95% CI = 1.36–3.66; P = 0.006) for zolpidem relative to alprazolam, 1.68 (95% CI = 1.12–2.53; P = 0.02) for zolpidem relative to lorazepam, and 1.29 (95% CI = 0.72–2.30; P = 0.32) for zolpidem relative to diazepam.

The researchers concluded that “in older adults, the risk of injury with zolpidem exceeded that with alprazolam and lorazepam and was similar to that with diazepam. If the associations are causal, then the high incidence of these fractures implies that these treatment induce a substantial number of fractures and consequential costs. Further study of the association is imperative.”