After a fracture, 73% of nursing home residents took a fall-risk drug and 4% a bisphosphonate

Design

Cross-sectional study, US Medicare claims and Minimum Data Set

Population

192,118 nursing home residents with a recent fracture in 14,559 homes

Primary outcome

Use of fall-risk drugs and oral bisphosphonates

Effect

Oral bisphosphonate 4.2%; any fall-risk drug 72.8% (opioids 26.7%)

This cross-sectional study used US Medicare claims and Minimum Data Set assessments for 192,118 nursing home residents with a recent hip or other fracture between 2017 and 2022. Mean age was 83.8.

Only 4.2% had an oral bisphosphonate prescription, and only 18.8% had osteoporosis diagnosed. By contrast, 72.8% were taking at least one of 18 drug classes linked to injurious falls; the commonest were statins (31.1%), opioids (26.7%), newer anticonvulsants (22.1%) and loop diuretics (22.1%).

The residents at highest risk of the next fracture are the least likely to be treated for bone fragility and the most likely to be on drugs that make falls more harmful.

The practical response has two halves: start fracture prevention, and review the falls-risk drugs, especially opioids and anticonvulsants.

• After any fracture in a care home resident, record osteoporosis as a diagnosis and consider treatment.
• Consider zoledronic acid where oral bisphosphonates are impractical.
• Review opioids and newer anticonvulsants first; they are common and often reducible.
• Check vitamin D and calcium intake.

Why it matters

Secondary fracture prevention in care homes is failing on both fronts: too few bone drugs and too many falls-risk drugs.

Don't overread it

This cross-sectional study counted oral bisphosphonates only, so residents on injectable treatments were not captured.

The statistics, in plain English

These are descriptive proportions, not comparisons of outcomes. They show prescribing patterns but cannot show whether changing them would prevent fractures in this population.

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