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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Geriatrics 1/2014

Handgrip strength and balance in older adults following withdrawal from long-term use of temazepam, zopiclone or zolpidem as hypnotics

BMC Geriatrics > Ausgabe 1/2014
Janne Nurminen, Juha Puustinen, Ritva Lähteenmäki, Tero Vahlberg, Alan Lyles, Markku Partinen, Ismo Räihä, Pertti J Neuvonen, Sirkka-Liisa Kivelä
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2318-14-121) contains supplementary material, which is available to authorized users.

Competing interests

JP has lectured in continuing education courses for physicians, nurses and physiotherapists sponsored by Boehringer-Ingelheim, Lundbeck, Novartis, ProEdu, Professio and given a consultation for PharmaQuest Ltd. RL is a shareholder of Orion and Novo Nordisk. AL has served on Advisory Boards for or consulted with Novo Nordisk, Pfizer and Sanofi-Aventis Group. PJN is a shareholder of Orion. MP has received honorariums for lecturing from Cephalon, Glaxo Smith Kline, Leiras-Nycomed, Servier and UCB and has been a member of the Medical Advisory Board of UCB. IR has given lectures in continuing education courses for physicians and nurses sponsored by Novartis and Janssen-Cilag. SLK has given lectures in continuing education courses for physicians, nurses and physiotherapists sponsored by Lundbeck, Ratiopharm and Leiras. JN and TV have no competing interest.
This study was financially supported by Nycomed, Satakunta Hospital District Grant EVO, Southwest Finland Hospital District Grant EVO, Municipality of Härkätie Grant EVO, the City of Turku’s Welfare Division, and the Finnish Cultural Foundation. All authors are independent from sponsors. The sponsors had no role in design, collection, analysis or interpretation of the data or writing the paper.

Authors’ contributions

JN has written the manuscript and has been planning the data analyses. JP has taken part in planning the analyses and he has critically revised the manuscript before submission. RL has been collecting the Satauni Study data and she has assisted the writing process of the methods section. TV has been planning the data analyses, supervised the analysis process and assisted the writing process of the methods and results sections. AL has critically revised and proofread the manuscript before submission. MP, IR, and S-LK have mentored the writing process. They have also designed the Satauni Study protocol and supervised the study execution. PJN has been responsible for drug determinations and has made substantial contributions to data interpretation and writing of the manuscript. All authors read and approved the final manuscript.



Benzodiazepines and related drugs affect physical functioning negatively and increase fall and fracture risk. As impaired muscle strength and balance are risk factors for falls, we examined the effects of hypnotic withdrawal on handgrip strength and balance in older adult outpatients during and after long-term use of temazepam, zopiclone and zolpidem (here collectively referred to as “benzodiazepines”).


Eighty-nine chronic users (59 women, 30 men) of temazepam, zopiclone or zolpidem aged ≥55 years participated in a benzodiazepine withdrawal study. Individual physician-directed withdrawal was performed gradually over a one-month period and participants were followed up to six months. Handgrip strength was assessed using a handheld dynamometer, and balance using the Short Berg’s Balance Scale during the period of benzodiazepine use (baseline), and at 1, 2, 3 weeks, and 1, 2 and 6 months after initiating withdrawal. Withdrawal outcome and persistence were determined by plasma benzodiazepine-determinations at baseline and at four weeks (“short-term withdrawers”, n = 69; “short-term non-withdrawers”, n = 20), and by interviews at six months (“long-term withdrawers”, n = 34; “long-term non-withdrawers”, n = 55). Also most of the non-withdrawers markedly reduced their benzodiazepine use.


Within three weeks after initiating withdrawal, handgrip strength improved significantly (P ≤ 0.005) compared to baseline values. Among women, long-term withdrawers improved their handgrip strength both when compared to their baseline values (P = 0.001) or to non-withdrawers (P =0.004). In men, improvement of handgrip strength from baseline was not significantly better in withdrawers than in non-withdrawers. However, men did improve their handgrip strength values compared to baseline (P = 0.002). Compared to balance test results at baseline, withdrawers improved starting from the first week after withdrawal initiation. There was, however, only a borderline difference (P = 0.054) in balance improvement between the long-term withdrawers and long-term non-withdrawers. Of note, the non-withdrawers tended to improve their handgrip strength and balance compared to baseline values, in parallel with their reduced benzodiazepine use.


Withdrawal from long-term use of benzodiazepines can rapidly improve muscle strength and balance. Our results encourage discontinuing benzodiazepine hypnotics, particularly in older women who are at a high risk of falling and sustaining fractures.

Trial registration

EU Clinical Trials Register: EudraCT200800067​9530. Registered 31 October 2008
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