Research Finds Geographical Variation in Fracture-Associated Drug Use Among Long-Term Care Facility Residents


Investigators found an average difference of 12% in the range of fracture-associated drug prescribing when comparing hospital referral regions.

A new study published in the Journal of General Internal Medicine has found substantial variation across different regions of the country in the intensity of fracture-associated drug (FAD) drug use among long-term care (LTC) facility residents. The investigators also found that areas with greater use of these drugs experience higher hip fracture rates.

Use of prescription medications has increased dramatically across the United States in recent decades due to improved ability to detect disease, expanded treatment options, and an aging population. For many Americans over 65 years of age, these medications can manage disease while improving quality of life and longevity.

However, the investigators noted that many commonly prescribed drugs are known to carry an increased risk of breaking a bone, including opioids, sleep aids, diuretics, antidepressants, and antacids. This is especially true for patients whose fracture risk is already high due to conditions such as osteoporosis.

Researchers sought to determine how much regional variation exists in the intensity of FAD use in LTC facilities and to assess the association between this intensity and hip fracture rates. They analyzed Medicare administrative data and the prescription records of 422,111 LTC residents, comparing FAD use across hospital referral regions. They observed more than 36,409 hip fractures among these residents over an 8-year period between 2006 and 2014.

“In our previous research, we showed that combining 3 or more FADs carried up to a 4-fold risk of hip fracture for Medicare beneficiaries, and that exposure to these medications for residents of long-term care facilities was nearly twice that of those living in the community setting,” said lead author Rebecca Emeny, PhD, MPH, a research scientist at the Dartmouth Institute for Health Policy and Clinical Practice, in a press release.

The new research found that areas with the greatest multiple FAD use intensity, defined as areas with at least 3 FADs prescribed, were in the southeast in Mississippi, Louisiana, and Florida. The areas with the lowest intensity were in New York, Oregon, New Mexico, Hawaii, and Arizona.

The investigators found an average difference of 12% in the range of FAD prescribing when comparing hospital referral regions. Furthermore, they determined that the risk of fractures was approximately 14% higher for residents in the highest intensity prescribing areas compared with the lowest.

“Seeing such variation in the intensity of prescribing of these risky drugs across this vulnerable population adds to the evidence that guidelines aren’t necessary being followed,” Emeny said in the press release. “We hope these results contribute to a more considerate weighing or risks and benefits when combinations of these medications are prescribed.”


Geisel Study Examines Regional Variation in Intensity of Fracture-Associated Prescription Drug Use [news release]. Dartmouth Geisel School of Medicine; February 16, 2021. Accessed February 18, 2021.

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