Reply to: Re‐Examining Sedative and Hypnotic Prescribing Following Hip Fracture

We thank Koizia et al. [1] for their interest in our study examining refill patterns of benzodiazepines and hypnotic drugs (Z-drugs) following hospitalization for hip fracture among US adults [2]. Their letter highlights the clinical complexity of post-hip fracture recovery and the difficult balance between short-term symptom management and longer-term medication safety. We agree that symptoms such as anxiety, sleep disturbance, and pain contributed meaningful complexity to prescribing decisions during post-hip fracture recovery, highlighting the importance of continued evaluation and patient-centered shared decision-making. We acknowledged methodological and data limitations in our study [2]. Refill-based exposure measurement using dispensing claims may not fully capture clinical prescribing decisions or patient adherence. However, dispensing records reflect continued access to these medications and therefore serve as an indicator of potential exposure during a period when patients recovering from hip fractures remain vulnerable to preventable adverse effects (e.g., recurrent falls). We also agree that different discharge settings may influence how sedatives are prescribed. We now have added a sensitivity analysis stratified by discharge setting (Figure 1, Table 1). Patients discharged home (Figure 1a; n = 2600, 12%) refilled earlier and were more likely to refill the same/increased dose rather than a reduced dose compared with those discharged to skilled nursing facilities (SNF) (Figure 1b; n = 18,523, 88%), considering that medications dispensing during SNF stays may not always be captured in the claims. These patterns may reflect that patients discharged home were generally younger and healthier than those discharged to SNFs and, therefore, more likely to continue their pre-fracture care and medication regimens [3, 4]. Alternatively, they may reflect increased efforts in dose reduction during post-acute SNF stays. We acknowledge that continuation of sedative and hypnotic medications following hip fracture may reflect unmet supportive needs. However, information on the non-pharmacologic supports (e.g., cognitive behavioral therapy, mindfulness-based interventions) for anxiety and pain was limited in our data, and these supports are, unfortunately, rarely utilized after hip fracture [5]. Finally, we share the authors' interests in extending this work across fracture types and healthcare systems. Future research examining refill patterns after other fractures could provide broader insight into post-injury prescribing dynamics. Additionally, studies conducted across healthcare systems and countries with different models of geriatric care and prescribing practices will be important for assessing the generalizability of these findings. Such work may help clarify how prescribing patterns differ across care settings and inform strategies to optimize medication safety for older adults recovering from fractures. Correspondence letter concept: M.P., D.H.K., and T.S. Acquisition, analysis, and interpretation of data: M.P. and V.P.; Preparation of the initial draft: M.P. Critical revision of the manuscript for important intellectual content: all authors. All listed authors contributed significantly to this correspondence letter and have approved the final version of the letter. The authors have nothing to report. No sponsor had any role in the study. T.S. receives investigator-initiated research funding and support as Principal Investigator (R01AG056479) from the National Institute on Aging (NIA), and as Co-Investigator (R01CA277756) from the National Cancer Institute, National Institutes of Health (NIH). He also receives salary support as Director of Comparative Effectiveness Research (CER), NC TraCS Institute, UNC Clinical and Translational Science Award (UM1TR004406), co-Director of the Human Studies Consultation Core, NC Diabetes Research Center (P30DK124723), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the Center for Pharmacoepidemiology (current members: GlaxoSmithKline, UCB BioSciences, Takeda, AbbVie, Boehringer Ingelheim, Astellas, and Sarepta), and from a generous contribution from Dr. Nancy A. Dreyer to the Department of Epidemiology, University of North Carolina at Chapel Hill. Dr. Til Stürmer does not accept personal compensation of any kind from any pharmaceutical company. He owns stock in Novartis, Roche, and Novo Nordisk. E.M.M. is supported by the National Institute of Environmental Health Sciences through Grant Award Number T32ES007018. This publication is linked to a related reply article by Koizia J et al. To view this article, visit https://doi.org/10.1111/jgs.70502.