After a fracture, nursing home residents were far likelier to be on fall-risk drugs than bisphosphonates

Design

Cross-sectional study of Medicare and MDS data, 2017-2022

Population

192,118 US nursing home residents with a recent fracture

Primary outcome

Use of fall-risk drugs and oral bisphosphonates

Effect

Oral bisphosphonate 4.2%; fall-risk drugs 72.8%

This cross-sectional study, published in August, used US Medicare data on 192,118 nursing home residents with a recent hip or other fracture between 2017 and 2022. Mean age was 84, and three-quarters were women.

Only 4.2% had an oral bisphosphonate prescription, and only 18.8% had a recorded osteoporosis diagnosis. In contrast, 72.8% were taking at least one drug linked to injurious falls — most often statins, opioids, newer anticonvulsants such as gabapentinoids, and loop diuretics.

The study did not look at parenteral osteoporosis treatment, and some fall-risk drugs are clearly indicated. It describes prescribing, not outcomes.

The practical reading is two-sided: secondary fracture prevention in care homes needs both bone treatment and a review of drugs that make falls more likely.

• Only 4.2% of residents with a recent fracture had an oral bisphosphonate.
• Seventy-three per cent were on at least one fall-risk drug.
• Opioids and newer anticonvulsants are common, reviewable candidates.
• Record osteoporosis as a diagnosis after a fragility fracture.
• Combine bone treatment with a falls-focused medicine review.

Why it matters

Care home residents with a fracture are at very high risk of the next one, yet almost none were on oral bone treatment.

Don't overread it

The study counted only oral bisphosphonates, so it underestimates overall osteoporosis treatment.

The statistics, in plain English

These are descriptive percentages. Because injectable treatments were not counted, true osteoporosis treatment rates may be somewhat higher than 4.2%.

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