Exposure to Drugs Related to Injurious Falls Risk and to Bisphosphonates in Nursing Home Residents With Recent...

To describe the frequency of use of drugs related to injurious falls risk (DRIFR) and oral bisphosphonates in nursing home (NH) beneficiaries with Medicare fee for service and Part D who had sustained a recent fracture.

This is a cross-sectional study using data from January 1, 2017 to June 30, 2022. DRIFR included 18 medication classes. Use of DRIFRs and oral bisphosphonates was ascertained in the 30 days of NH care before a defined index date (day 31 for new residents; study start date for prevalent residents) using Part D claims.

We analyzed data from 14,559 NHs in the United States comprising 192,118 residents with a recent hip or other fracture, defined using a federally mandated clinical assessment (Minimum Data Set).

Patient characteristics were identified from the most recent Minimum Data Set (≤92 days before index date). Descriptive statistics were calculated using t tests, Wilcoxon rank-sum test, or χ² tests. Patient characteristics and medication use were stratified by bisphosphonate prescriptions (yes/no).

Of recent fractures, 41.4% of residents had hip fractures, and 67.7% had fractures at other sites. Mean age was 83.8 years (range, 65-110); 75.4% were female; 86.5% were non-Hispanic White. Osteoporosis was diagnosed in 18.8% of residents and was more common among those with bisphosphonate prescriptions than among those without. Only 4.2% of residents had bisphosphonate prescriptions, whereas 72.8% had prescriptions of DRIFRs. Common DRIFRs included statins (31.1%), opioids (26.7%), newer anticonvulsants (22.1%), and loop diuretics (22.1%).

Use of DRIFRs is common, whereas oral bisphosphonates are rarely prescribed in residents with a recent fracture receiving care in NHs. Our results suggest that opioids and newer anticonvulsants may represent common candidates for medication review. Efforts to treat fractures and prevent secondary fractures should not only focus on increasing bisphosphonate treatment but also on deprescribing DRIFR.