Sedative-Hypnotic Drug Use and Polypharmacy Patterns Associated With Risk of Falls and Fractures in Older Adults by Osteoporosis Status: A Korean Nationwide Senior Cohort Study
Author(s)
Minkyoung Kang, R.Ph., B.S.1, Jaehee Jung, R.Ph., B.S.1, Hyeun Ah KANG, M.Ed., M.S., R.Ph., Ph.D.2, Hye-Young Kang, R.Ph., Ph.D.1.
1College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Korea, Republic of, 2University of Texas at Austin, Austin, TX, USA.
1College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Korea, Republic of, 2University of Texas at Austin, Austin, TX, USA.
OBJECTIVES: This research aimed to examine the association between sedative-hypnotic drug (SHD) use and the risk of falls and fractures among older adults with and without osteoporosis, using a representative Korean population cohort.
METHODS: We analyzed data from the 2013-2017 Korean National Health Insurance Senior Cohort Database. Individuals aged 65 or older in 2017 were included. Patients with osteoporosis were defined as those with an osteoporosis diagnosis and concurrent prescription of osteoporosis medications. Bivariate analyses compared fall/fracture incidence by SHD use and by the number of concurrently prescribed SHD ingredients and categories, separately. Logistic regression was used to evaluate the association between SHD use and fall/fracture risk, adjusting for demographics, prior fractures, and comorbidities. Subgroup analyses examined fall, fracture, and combined risks, stratified by osteoporosis status.
RESULTS: Among the 572,902 included individuals, 56,735 had osteoporosis. SHD users demonstrated elevated fall/fracture incidences than non-users in both groups: 25.29% vs. 20.56% (osteoporotic) and 5.71% vs. 3.43% (non-osteoporotic). Among osteoporotic patients, incidence increased from 24.06% with one ingredient, to 27.63% with two, and 31.57% with three or more. Among non-osteoporotic patients, rates were 5.43%, 6.58%, and 7.43%, respectively. A similar dose-response pattern was observed for the number of SHD categories. Adjusted odds ratios indicated an elevated risk with SHD use, compared to non-users: 1.287 (95% CI: 1.236-1.341) for osteoporotic and 1.543 (95% CI: 1.488-1.600) for non-osteoporotic patients. Subgroup analysis demonstrated a greater fracture risk among non-osteoporotic patients, whereas osteoporotic patients had a higher fall risk.
CONCLUSIONS: SHD use was associated with increased fall and fracture risks in older adults regardless of osteoporosis status. The higher fracture risk in non-osteoporotic patients potentially indicates insufficient preventive interventions, while greater fall risk in osteoporotic patients probably stems from frailty. These findings underscore the need for safer prescribing and initiatives to reduce SHD polypharmacy in older adults.
METHODS: We analyzed data from the 2013-2017 Korean National Health Insurance Senior Cohort Database. Individuals aged 65 or older in 2017 were included. Patients with osteoporosis were defined as those with an osteoporosis diagnosis and concurrent prescription of osteoporosis medications. Bivariate analyses compared fall/fracture incidence by SHD use and by the number of concurrently prescribed SHD ingredients and categories, separately. Logistic regression was used to evaluate the association between SHD use and fall/fracture risk, adjusting for demographics, prior fractures, and comorbidities. Subgroup analyses examined fall, fracture, and combined risks, stratified by osteoporosis status.
RESULTS: Among the 572,902 included individuals, 56,735 had osteoporosis. SHD users demonstrated elevated fall/fracture incidences than non-users in both groups: 25.29% vs. 20.56% (osteoporotic) and 5.71% vs. 3.43% (non-osteoporotic). Among osteoporotic patients, incidence increased from 24.06% with one ingredient, to 27.63% with two, and 31.57% with three or more. Among non-osteoporotic patients, rates were 5.43%, 6.58%, and 7.43%, respectively. A similar dose-response pattern was observed for the number of SHD categories. Adjusted odds ratios indicated an elevated risk with SHD use, compared to non-users: 1.287 (95% CI: 1.236-1.341) for osteoporotic and 1.543 (95% CI: 1.488-1.600) for non-osteoporotic patients. Subgroup analysis demonstrated a greater fracture risk among non-osteoporotic patients, whereas osteoporotic patients had a higher fall risk.
CONCLUSIONS: SHD use was associated with increased fall and fracture risks in older adults regardless of osteoporosis status. The higher fracture risk in non-osteoporotic patients potentially indicates insufficient preventive interventions, while greater fall risk in osteoporotic patients probably stems from frailty. These findings underscore the need for safer prescribing and initiatives to reduce SHD polypharmacy in older adults.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH210
Topic
Epidemiology & Public Health, Methodological & Statistical Research, Real World Data & Information Systems
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
Geriatrics, Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)