Z-drugs and risk for falls and fractures in older adults-a systematic review and meta-analysis
I'm an older adult — given the roughly doubled injury odds on zolpidem, is there a safer way for me to handle insomnia, or a reason it's still the right choice?
Reasonable evidence with real limitations. how we score evidence
Caveat on this rating: Observational studies only — people prescribed hypnotics differ from those who aren't, so confounding by insomnia itself and by frailty cannot be excluded; fall results were heterogeneous and not statistically significant.
Pooling 14 observational studies covering 830,877 older adults, z-drug use was associated with 1.63 times the odds of fractures, and zolpidem specifically with about twice the odds of injury (OR 2.05, 160,502 people in that analysis).
Worth asking
I'm an older adult — given the roughly doubled injury odds on zolpidem, is there a safer way for me to handle insomnia, or a reason it's still the right choice?
What it is FDA approved for
Read off the label. Trial duration and approval year are shown only where they were recorded — never inferred.
- Short-term treatment of insomnia characterized by difficulties with sleep initiation
Source
Z-drugs and risk for falls and fractures in older adults-a systematic review and meta-analysis — Treves N, et al. (2018)
Reputable peer-reviewed journal
Read the source: https://doi.org/10.1093/ageing/afx167
DOI: 10.1093/ageing/afx167
How this was scored
- Study design
- Systematic review of observational studies
- Funding
- Funding not disclosed
- Published in
- Reputable peer-reviewed journal
- Sample size
- 830,877
- Preregistered
- No
- Conflicts disclosed
- No
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published August 19, 2026.
Questions
How strong is the evidence behind this?
Resolv rates this source "moderate evidence". Reasonable evidence with real limitations. It scores 59 out of 100 on our published rubric. One caveat travels with that badge: Observational studies only — people prescribed hypnotics differ from those who aren't, so confounding by insomnia itself and by frailty cannot be excluded; fall results were heterogeneous and not statistically significant. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Z-drugs and risk for falls and fractures in older adults-a systematic review and meta-analysis — Treves N, et al. (2018). Published in: Reputable peer-reviewed journal. DOI: 10.1093/ageing/afx167. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Systematic review of observational studies. Funding: Funding not disclosed. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is zolpidem (Ambien, Edluar, Intermezzo), ambien, edluar, intermezzo FDA approved?
Yes — FDA approved for Short-term treatment of insomnia characterized by difficulties with sleep initiation. Approval is for a specific indication, not for everything the drug is prescribed for.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.