Does benzodiazepine increase fracture risk?


Benzodiazepine therapy has been liked to an increase risk of fracture in older adults. An investigation looks into whether the risk exists in the pediatric population.

Benzodiazepines are some of the most common pharmacologic tools used to treat anxiety disorders. Research has shown that they are linked to falls and fractures in older adults. A new investigation in Pediatrics examines whether there is a similar link in children and adolescents who take benzodiazepines.1

Investigators used insurance claims from commercially insured children and young adults who had a recent anxiety disorder diagnosis and had initiated benzodiazepines or selective serotonin reuptake inhibitors (SSRIs). Each participant was followed until fracture, treatment discontinuation or switching, disenrollment, for 3 months, or until December 31, 2016.

There were 120,715 children and 179,768 young adults. Among the children, the crude fracture rates during treatment were 33.1 per 1000 person-years (PYs) for benzodiazepine initiators and 25.1 per 1000 PYs for SSRI initiators. The risk was heightened among children who had initiated long-acting benzodiazepines in comparison with SSRIs. There were minimal differences seen between benzodiazepine and SSRIs and fracture risks in young adults.

The researchers concluded that when children are started on a benzodiazepine treatment for anxiety disorders, there should an increased level of caution to protect against fractures. Such caution appears to be unnecessary for young adults.


1.Bushnell GA, Gerhard T, Crystal S, Olfson M. Benzodiazepine treatment and fracture risk in young persons with anxiety disorders. Pediatrics. 2020;145(6):e20193478. doi: 10.1542/peds.2019-3478

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