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Algorithm now available to prevent recurrent bone fractures in nursing home residents

Research Activities, October 2009

Older adults who break their hips or bones in their spines are at high risk for suffering second fractures. Many of these fractures occur in nursing homes, but only a small percentage of residents receive osteoporosis therapy to prevent second fractures.

Amy H. Warriner, M.D., and Kenneth G. Saag, M.D., M.Sc., of the Center for Education and Research on Therapeutics (CERT) of Musculoskeletal Disorders, and coinvestigators reviewed the known risk factors for second fractures and developed an algorithm for assessing and treating osteoporosis in patients living in long-term care facilities or receiving home health care.

Active older adults are more likely to suffer second fractures, largely because their mobility presents them with more opportunities to fall, the researchers found. Home safety assessments, vision screenings, and medication reviews may help prevent second falls. Low levels of vitamin D also appear to be a risk factor for falls, because that vitamin aids musculoskeletal function.

The researchers recommend that elderly patients be given both vitamin D and calcium to reduce their risk of breaking bones. However, patients with a history of fracture or osteoporosis should also be treated with osteoporosis medications, even if bone mineral density evaluation is not possible. These drugs vary in their ability to prevent fractures. The bisphosphonates alendronate and risedronate appear effective in preventing all types of fractures, while other drugs appear to significantly reduce spine or hip fractures, but not both. Individuals who take bisphosphonates and continue to suffer fractures may be candidates for teriparatide, a more expensive drug that is administered via daily injections.

This study was funded in part by the Agency for Healthcare Research and Quality (HS16956) to the University of Alabama at Birmingham CERT. For more information on the CERTs program, visit

See "Management of osteoporosis among home health and long-term care patients with a prior fracture," by Dr. Warriner, Ryan C. Outman, M.A., Jeffrey R. Curtis, M.D., M.P.H., Dr. Saag, and others in the April 2009 Southern Medical Journal 102(4), pp. 397-404.

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Page last reviewed October 2009
Internet Citation: Algorithm now available to prevent recurrent bone fractures in nursing home residents: Research Activities, October 2009. October 2009. Agency for Healthcare Research and Quality, Rockville, MD.