Falls Happen, With or Without Valium

In 1989 New York State required all prescriptions for benzodiazepines (e.g. Valium®, Xanax®) to be written in triplicate. This had the effect of a 60% reduction in prescribing these drugs in New York State, while they remain unchanged in New Jersey, the state next door. There was a theory that a sudden decrease in the use of these sedating drugs would result in a decrease in the frequency of hip fractures.

The hip fracture rates and benzodiazepine prescribing in Medicaid patients over 65 the two states have now been published in the Annals of Internal Medicine. The hoped-for decrease in fractures didn’t occur. Hip fractures remained as frequent as before, both in New York State and in New Jersey.

How to explain the findings, which differ from those in smaller studies? The authors of the study suggest that the previous investigators did not adjust their findings adequately to account for the influences of body mass index, smoking, physical activity, mental impairment, and so on. They believe that benzodiazepine use may be only one factor (and obviously a very small one) in the causation of hip fracture in the elderly. I imagine that falls (and the environmental factors causing them in the home and on the street) are still the most important causal event.