After hip fracture, benzodiazepine use fell sharply but opioid dispensing stayed high

Design

Population-based retrospective cohort using linked administrative data

Population

114,055 adults aged 66 or over admitted with hip fracture in Ontario, 2008-2024

Primary outcome

Opioid and benzodiazepine dispensing within 1 year of discharge

Effect

Benzodiazepines 33.7% to 13.3%; opioids peaked 55.8% (2015), 44.6% in 2024

This population-based cohort used linked Ontario health data on 114,055 adults aged 66 or over admitted with hip fracture between 2008 and 2024 who survived most of the following year. It tracked opioid and benzodiazepine dispensing in the year after discharge.

Benzodiazepine dispensing after discharge fell from 33.7% in 2008 to 13.3% in 2024, and concurrent opioid and benzodiazepine dispensing from 3.7% to 1%. Opioid dispensing peaked at 55.8% in 2015 and was still 44.6% in 2024. Among those on continuous opioids for 90 days, most were on less than 50 mg morphine equivalent a day.

The decline in benzodiazepines shows prescribing can change. Opioids remain important for pain after hip fracture, but nearly half of patients receiving them in the following year suggests room for planned tapering and non-opioid analgesia, given their contribution to falls and confusion.

• Plan the duration and taper of opioids at discharge after hip fracture.
• Use regular paracetamol and non-drug measures as the base of analgesia.
• Avoid starting benzodiazepines for sleep or anxiety after hip fracture.
• Review all sedating drugs at follow-up as part of falls prevention.
• Avoid combining opioids and benzodiazepines in older patients.

Why it matters

Sedating drugs after a fall-related fracture raise the risk of the next fall.

Don't overread it

Dispensing records show prescriptions filled, not doses taken or whether pain was adequately controlled.

The statistics, in plain English

These are proportions of patients with at least one prescription in the year after discharge, so a single short course counts the same as long-term use.

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