Study finds comparable fracture risk between suvorexant and Z‐drugs

Benzodiazepines and Z‐drugs are widely prescribed to manage insomnia, but there have been concerns over adverse effects such as dizziness, drowsiness, and related complications, such as fracture risk in older patients. Based on evidence that the dual orexin receptor antagonist suvorexant could improve insomnia with less potential for adverse effects, researchers in Japan conducted a retrospective cohort study to compare the safety of suvorexant and Z‐drugs in community‐dwelling older adults. The investigators used insurance claims data from the Longevity Improvement and Fair Evidence study, examining data from Sept. 1, 2014 to Dec. 31, 2020. Included in the analysis were adults aged 65 and older. Drug exposure was defined as first prescription of suvorexant or the Z‐drugs zopiclone, zolpidem, or eszopiclone. The outcomes of interest were hip fracture and all‐cause fracture requiring hospitalization. A number of demographic and illness factors were considered as covariates. The analysis encompassed just over 70,000 new users of suvorexant or a Z‐drug. Hip fracture incidence rates over 30‐day follow‐up were 16.6 per 1,000 person‐years in the suvorexant group and 12.2 per 1,000 person‐years in the Z‐drugs group. All‐cause fracture rates at 30 days were 69 per 1,000 person‐years in the suvorexant group and 51.7 per 1,000 person‐years in the Z‐drugs group. The between‐group differences in fracture rates were similar at 90 and 365 days, the researchers reported. Sensitivity analyses generally confirmed the main findings, except that initiators of suvorexant showed an increased risk of all‐cause fracture requiring surgery at 30 days. “Further study is warranted to evaluate the potential short‐term increased risk, which clinicians may need to consider when treating patients with insomnia,” the study's authors wrote. [Adomi M, et al. J Am Geriatr Soc 2022; published online Oct 2; doi: 10.1111/jgs.18068]