{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:49:28Z","timestamp":1791524968377,"version":"4.3.4"},"reference-count":33,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare","doi-asserted-by":"publisher","award":["23AA2003"],"award-info":[{"award-number":["23AA2003"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lemborexant and suvorexant are widely used dual orexin receptor antagonists (DORAs) for the pharmacological treatment of insomnia. Although they are generally considered safer than benzodiazepine receptor agonists (Z\u2010drugs) regarding adverse events including hip fractures, evidence from direct comparisons remains limited. This study aimed to examine whether lemborexant and suvorexant are associated with a lower risk of hip fracture than Z\u2010drugs in older individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cohort study using databases from Tochigi Prefecture, Japan. We included individuals aged \u2265\u200965\u2009years who newly initiated either lemborexant or Z\u2010drugs (lemborexant analysis cohort) or either suvorexant or Z\u2010drugs (suvorexant analysis cohort). The primary outcome was hospitalization for hip fracture within 1\u2009year of cohort entry. Per\u2010protocol effects of continuous treatment with the assigned drugs were estimated. Baseline confounding was adjusted using inverse probability of treatment weighting based on propensity scores. Censoring due to discontinuation of the assigned drug or switching to the comparator drug was adjusted for using inverse probability of censoring weights. Adjusted cumulative incidence and hazard ratios (HRs) were estimated using the Kaplan\u2013Meier methods and Cox regression, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The lemborexant analysis cohort included 22,655 individuals (6879 and 15,776 in the lemborexant and Z\u2010drug groups, respectively). After adjustment, lemborexant use was associated with a significantly lower hip fracture incidence (HR, 0.31, 95% confidence interval [CI], 0.16\u20130.59,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The suvorexant analysis cohort included 22,377 individuals (6699 and 15,678 in the suvorexant and Z\u2010drug groups, respectively). After adjustment, hip fracture incidence was lower in the suvorexant group, but the association was not significant (HR, 0.57, 95% CI, 0.23\u20131.44,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.234).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>DORAs, particularly lemborexant, may be safer alternatives to Z\u2010drugs with respect to hip fracture risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70754","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:55:57Z","timestamp":1791521757000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hip Fracture Risk of Lemborexant and Suvorexant in Comparison With Z\u2010Drugs: A Target Trial Emulation"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8804-8628","authenticated-orcid":false,"given":"Yuichiro","family":"Matsuo","sequence":"first","affiliation":[{"name":"Department of Clinical Epidemiology and Health Economics Graduate School of Medicine, The University of Tokyo  Tokyo Japan"},{"name":"Data Science Center Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayato","family":"Yamana","sequence":"additional","affiliation":[{"name":"Data Science Center Jichi Medical University  Tochigi Japan"},{"name":"Clinical Research Center National Hospital Organization Headquarters  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Sasabuchi","sequence":"additional","affiliation":[{"name":"Data Science Center Jichi Medical University  Tochigi Japan"},{"name":"Department of Real\u2010World Evidence, Graduate School of Medicine The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Matsui","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Health Economics Graduate School of Medicine, The University of Tokyo  Tokyo Japan"},{"name":"Data Science Center Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahide","family":"Kohro","sequence":"additional","affiliation":[{"name":"Data Science Center Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideo","family":"Yasunaga","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Health Economics Graduate School of Medicine, The University of Tokyo  Tokyo Japan"},{"name":"Data Science Center Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsab258"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsmc.2022.03.003"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/smrv.2002.0186"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.7326\/aitc202103160"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41999\u2010021\u201000481\u20109"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.296.15.1858"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.12594"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/m15\u20102175"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2017.12.098"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.164.14.1567"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198\u2010016\u20103605\u20108"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1474\u20104422(14)70053\u20105"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.18254"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsaa123"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010023\u201004683\u20102"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/pcn5.113"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1168100"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18068"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0284726"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40266\u2010023\u201001033\u20105"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.71049"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.13350"},{"key":"e_1_2_10_24_1","first-page":"28","volume-title":"NDB. 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