Older individuals with insomnia who take lemborexant have a lower risk of hip fracture than those who take benzodiazepine receptor agonists (Z-drugs) such as zolpidem, zopiclone, or eszopiclone, a
study in the
Journal of the American Geriatrics Society has found.
Why It’s Relevant
Z-drugs have side effects such as lightheadedness, dizziness, sleepwalking, and severe drowsiness, all of which may contribute to an increased risk of falls in older people. The American Geriatrics Society
Beers Criteria lists Z-drugs as potentially inappropriate for adults 65 and older. Dual orexin receptor antagonists such as lemborexant and suvorexant are believed to be safer, but real-world evidence is still limited.
By the Numbers
- Researchers analyzed data from two cohorts of adults age 65 years or older in Tochigi Prefecture, Japan, who had newly initiated medication for insomnia. In the first cohort, 6,879 individuals took lemborexant and 15,776 took a Z-drug. In the second cohort, 6,699 individuals took suvorexant and 15,678 took a Z-drug.
- Compared with individuals who took a Z-drug, those who took lemborexant had a 69% lower risk of hospitalization for a hip fracture within a year. In a subgroup analysis, individuals 65 to 84 who took lemborexant had an 80% lower risk while individuals 85 and older had a 60% lower risk.
- Individuals who took suvorexant had a 43% lower risk of hospitalization for a hip fracture within a year, but that association was not statistically significant.
The Other Side
Adherence to the medications was relatively short (median 11 weeks for lemborexant, 10 weeks for suvorexant, and nine weeks for Z-drugs) and fractures were rare (about 0.23% of adults), so the magnitude of the results may be overstated. In addition, the outcomes were ascertained from claims data and may have been misclassified.
Takeaway Message
“Our findings suggest that [dual orexin receptor antagonists], particularly lemborexant, may be safer alternatives to Z-drugs regarding hip fracture risk,” the researchers wrote. “Nonetheless, considering inconsistencies with prior studies, further research is warranted before definitive conclusions can be drawn. Additionally, unrestricted prescribing of hypnotics to older adults is not recommended, and hypnotic use should be minimized regardless of drug class.”
Related Information
Source
Yuichiro Matsuo, et al. Hip fracture risk of lemborexant and suvorexant in comparison with z-drugs: A target trial emulation. Journal of the American Geriatrics Society. Published October 8, 2026. doi:10.1111/jgs.70754
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