Nursing home residents with a recent fracture: fall-risk drugs were common, bisphosphonates rare

Design

Cross-sectional study using Medicare claims and Minimum Data Set, 2017 to 2022

Population

192,118 nursing home residents with a recent hip or other fracture

Primary outcome

Prevalence of fall-risk drug and oral bisphosphonate use

Effect

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

This cross-sectional study used US Medicare claims and the federal Minimum Data Set for 192,118 residents of 14,559 nursing homes who had a recent hip or other fracture. It counted prescriptions in the 30 days before a defined index date for 18 classes of drugs related to injurious falls and for oral bisphosphonates.

Mean age was 83.8 years, and 75.4% were women. Prescriptions for fall-risk drugs were present in 72.8%, including statins (31.1%), opioids (26.7%), newer anticonvulsants (22.1%) and loop diuretics (22.1%). Oral bisphosphonates were prescribed to 4.2%. Osteoporosis was diagnosed in only 18.8%.

This is a description of prescribing, not a measure of whether any drug caused falls or whether the prescriptions were appropriate. Some are essential, such as the statin after a vascular event. The authors suggest opioids and newer anticonvulsants as common candidates for review and argue that preventing a second fracture should include deprescribing, not only starting bone treatment.

• After any fragility fracture, review the medicine list for drugs that raise falls risk.
• Opioids and newer anticonvulsants were common and may be the most reviewable.
• Ask whether osteoporosis has been assessed and recorded; only 18.8% of residents had the diagnosis.
• Consider bone-protective treatment where appropriate and in line with local guidance.
• Agree goals of care with the resident and family when weighing treatment burden.

Why it matters

Secondary fracture prevention is often framed as an osteoporosis drug problem, and this shows the medicines list is the larger and more modifiable target.

Don't overread it

A cross-sectional claims study in US nursing homes cannot show that deprescribing prevents fractures or that the prescriptions were inappropriate.

The statistics, in plain English

The percentages describe how often each drug was prescribed, not how risky it is. A high prevalence of a drug class does not mean it caused the fracture, and some of these drugs have important benefits that need weighing.

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