Effectiveness of suvorexant versus benzodiazepine receptor agonist sleep drugs in reducing the risk of hip fracture: Findings from a regional population-based cohort study

Abstract

Sleep drugs are often necessary to treat insomnia in older patients. Benzodiazepine receptor agonists (BZRAs) are primarily used for insomnia in these patients, but there are concerns regarding their association with delirium and bone fractures. Among sleep drugs, orexin receptor antagonists such as suvorexant have a lower risk of delirium than BZRAs, but their effectiveness in preventing hip fractures is unknown. Hip fracture is a life-threatening trauma in advanced-age patients and a social problem. Therefore, we investigated the relationship between suvorexant and hip fracture. The Shizuoka Kokuho Database was used to compare the time to hip fracture in patients who had been newly taking suvorexant and other sleep drugs such as benzodiazepines since November 2014. A proportional hazards model for hip fracture as an outcome was used to estimate the hazard ratio. Propensity scores were estimated using a logistic regression model, and the confounding factors were age, sex, several comorbidities, and each oral medication. The suvorexant group comprised 6860 patients (110 with hip fracture), and the BZRA group (benzodiazepines and Z-drugs) comprised 50,203 patients (1487 with hip fracture). In the matched cohort (6855:6855 patients), 259 and 249 patients in the suvorexant and BZRA group developed hip fractures during the observational period, respectively. The hazard ratio of the suvorexant group compared with the BZRA group was 1.48 (95% confidence interval, 1.20–1.82). In the subgroup analysis, patients in the suvorexant group had a higher risk of hip fracture if they were aged >75 years, had no diabetes, had no neurological disease, had no renal failure, had liver disease, had hypertension, were not taking alpha 1 blockers, and were not taking oral steroids. Among people in the Japanese regional population who use sleep drugs, patients taking suvorexant can be at higher risk of hip fracture than patients taking BZRAs.

Leukotriene antagonists reduce epileptic seizures‐related hospitalization in older adult populations with allergic rhinitis or asthma: A population‐based cohort study using the Shizuoka Kokuho database: The Shizuoka study

“…Located in the country's center, Shizuoka Prefecture is representative of Japan because it includes characteristics of nature, climate, industry, economy, and culture that are typical to the country. The SKDB includes information on a regional population‐based longitudinal cohort of 2 398 393 Japanese individuals (women, n = 1 303 667, 54.4%) living in Shizuoka Prefecture (population: approximately 3.6 million) 10 and has been used as a data source for several studies 11–13 . Comprehensive personally linked data were collected and all individuals were uniquely identified.…”

“…The SKDB includes information on a regional population‐based longitudinal cohort of 2 398 393 Japanese individuals (women, n = 1 303 667, 54.4%) living in Shizuoka Prefecture (population: approximately 3.6 million) 10 and has been used as a data source for several studies. 11 , 12 , 13 Comprehensive personally linked data were collected and all individuals were uniquely identified. The dataset includes basic information from the subscriber list (sex, age, zip code, observation period, and reason for disenrollment, including death).…”

“…The SKDB includes information on a regional population-based longitudinal cohort of 2 398 393 Japanese individuals (women, n = 1 303 667, 54.4%) living in Shizuoka Prefecture (population: approximately 3.6 million) 10 and has been used as a data source for several studies. [11][12][13] Comprehensive personally linked…”