- Design
- Cross-sectional study of Medicare claims and Minimum Data Set
- Population
- 192,118 US nursing home residents with recent fracture in 14,559 homes
- Primary outcome
- Use of bisphosphonates and drugs related to injurious falls
- Effect
- Bisphosphonates 4.2%; falls-risk drugs 72.8% (opioids 26.7%, newer anticonvulsants 22.1%)
A JAMDA cross-sectional study, published in August 2026, examined US nursing home residents enrolled in Medicare who had a recent hip or other fracture between 2017 and 2022 — 192,118 residents across 14,559 homes, with a mean age of 83.8.
Only 4.2% had an oral bisphosphonate prescription, and osteoporosis was recorded in just 18.8%. Meanwhile 72.8% were taking at least one of 18 drug classes linked to injurious falls, most commonly statins (31.1%), opioids (26.7%), newer anticonvulsants (22.1%) and loop diuretics (22.1%).
A fracture in an older person is itself a diagnosis of fragility and a strong predictor of the next fracture. The gap here is two-sided: bone protection is rarely started and falls-risk prescribing rarely reviewed. The authors point to opioids and newer anticonvulsants as the commonest candidates for review. Oral bisphosphonates may be impractical for some residents, and intravenous or injectable options are alternatives where appropriate. The study is descriptive and US-based.
- Record a diagnosis of osteoporosis after any fragility fracture in an older resident, and consider bone-protective treatment.
- Review opioids and newer anticonvulsants first when deprescribing after a fall-related fracture.
- Check vitamin D status and renal function before starting bone-protective treatment.
- Consider intravenous or injectable bone-protective options where oral bisphosphonates are impractical.
- Reassess loop diuretics and other blood pressure-lowering drugs for orthostatic symptoms.
Why it matters
A fracture is the clearest warning of the next one, yet bone protection reached fewer than one in twenty residents.
Don't overread it
This cross-sectional study describes prescribing patterns; it did not test whether changing them reduces fractures.
The statistics, in plain English
These are simple proportions, so the main message is the size of the gap: about 17 residents on a falls-risk drug for every one on a bisphosphonate.
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