Gerson T. Lesser, MD
Potential Financial Conflicts of Interest: None disclosed.
Lesser G.; Benzodiazepines and Hip Fractures. Ann Intern Med. 2007;147:347-348. doi: 10.7326/0003-4819-147-5-200709040-00016
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Published: Ann Intern Med. 2007;147(5):347-348.
TO THE EDITOR:
The use of hypnotics in general, and benzodiazepines in particular, has been largely proscribed in geriatric teaching and practice for some years. Wagner and coworkers (1) have served us well by showing definitively that an intervention effecting major reduction of benzodiazepine use in a large, vulnerable population failed to lower the incidence of hip fractures. The authors sensibly conclude that discrepancies between their observations and those of earlier reports are probably explained by unmeasured confounders. In a 1999 review and meta-analysis of psychotropic drugs and falls, Leipzig and colleagues (2) similarly noted the need for further adjustment for potential confounders.
Jonathan P. Krueger
April 13, 2008
Why prefer the larger problem?
The time required for a condition to not influence a subsequent conditions is certainly a problem for any within-participants design. However solutions include randomizing order of exposure to conditions, adding time of no treatment between conditions (a useful additional control in any case), and seeking guidance on how long influences persist from condition to condition.
Is it preferable to face a larger problem: higher variability, lower noise, lower power, and being unable to conclude whether the treatment reliably affects some subjects, separate from the overall effect?
Certainly it's true that menopausal symptoms change through time. That however is a stronger argument for within-participant designs, since when each participant is her own control, her symptom variability is not mixed with the other participants'.
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