After a fracture, 73% of nursing home residents were on falls-risk drugs and 4% on a bisphosphonate

Design

Cross-sectional study using Medicare fee-for-service and Part D claims with Minimum Data Set assessments, 2017 to 2022

Population

192,118 residents of 14,559 US nursing homes with a recent hip or other fracture (mean age 83.8)

Primary outcome

Prevalence of drugs related to injurious falls (18 classes) and oral bisphosphonates in the 30 days before the index date

Effect

Falls-risk drugs 72.8%; oral bisphosphonates 4.2%; opioids 26.7%; newer anticonvulsants 22.1%

This US cross-sectional study used Medicare claims and the nursing home Minimum Data Set to describe medication use in 192,118 residents of 14,559 nursing homes who had a recent hip or other fracture. Their mean age was 83.8, and 75.4% were women. In the 30 days after admission or study start, the authors counted 18 classes of drugs related to injurious falls and oral bisphosphonates.

Only 4.2% had a bisphosphonate prescription, while 72.8% had at least one drug related to injurious falls. The commonest were statins (31.1%), opioids (26.7%), newer anticonvulsants (22.1%) and loop diuretics (22.1%). Osteoporosis was recorded in 18.8%.

The study is descriptive, and some drugs on the list, such as statins, have strong indications. The authors argue that preventing a second fracture is not only about adding bisphosphonate therapy but about reviewing falls-related drugs, with opioids and newer anticonvulsants as the most obvious targets.

• Review every nursing home resident's medicines after a fracture, starting with opioids, anticonvulsants and sedatives.
• Consider whether a bisphosphonate or other osteoporosis treatment is appropriate; most residents in this study had none.
• Do not stop a drug with a clear indication without an alternative plan.
• Record the reason for each drug that raises falls risk and set a review date.
• Involve the pharmacist and treating specialist when changing long-term drugs.

Why it matters

A fracture is the moment when both fall risk and bone fragility are visible, and neither is often addressed.

Don't overread it

A US descriptive study using claims data; it does not show that deprescribing or bisphosphonate use prevents fractures, and it counted drugs, not appropriateness.

The statistics, in plain English

This is a descriptive count, so it cannot say that these prescriptions caused fractures or that stopping them prevents more. Some residents may have had reasons not to take a bisphosphonate, such as swallowing problems or limited life expectancy, which claims data do not show.

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