The common side effects of taking a benzodiazepine (BZD) for anxiety are well known: drowsiness, dizziness, and slow-reaction time—all ingredients in the making of an injury or accident. This association between BZD use in an anxious adults and a fracture from unintentional falls has been shown in the adult literature, but what about children and young adults? Bushnell et al (10.1542/peds.2019-3478) used a large national claims database to compare fracture rates of children with anxiety who used BXD or a selective serotonin re-uptake inhibitor (SSRI). The authors analyzed over 12,800 children and 57,600 young adults on BZDs between 2008 and 2016 and found an increased rate of upper and lower limb fractures among children (especially boys) and those with ADHD but not among young adults. Long-acting BZDs were associated with a greater fracture rate among children.
The authors speculate that young adults are less active and thus less prone to having a fall that could cause a fracture compared to children. They may also be more aware of the potential side effects that can accompany BZD use. The authors point out that their database could only tell if prescriptions were filled but not if and when the BZD was taken and had no measure of the severity of the anxiety disorder. The study also did not include consideration of other psychiatric co-morbidities due to sample size issues.
Despite these limitations, the authors found an association in children that has been reported in adults. Should this make you anxious about prescribing a BZD? It is important to make sure families understand the risk of these medications.
