Regional Variation in Fracture-Associated Prescription Drug Use and Hip Fractures in Long-Term Care: an Observational Study

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The authors wish to thank Atlas Editor, Kristen Bronner, MA, for graphical expertise and Professor Jonathan Skinner, PhD, for review of early manuscript drafts.


RTE and NEM were supported by the National Institute on Aging: P01 AG019783, Skinner (PI): Causes and Consequences of Healthcare Efficiency. JB was funded in part by the National Institute on Aging of the National Institutes of Health under Award Number K23AG051681.

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Correspondence to Rebecca T. Emeny PhD or Nancy E. Morden MD.

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The Dartmouth Protection of Human Subjects Committee approved this study.

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The authors declare that they do not have a conflict of interest.


The views expressed in this article are those of the authors and no endorsement by the NIA or the NIH is intended or should be inferred.

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Question: How much regional variation exists in the intensity of fracture-associated drug use in the long-term care (LTC) setting, and how is this variation associated with fracture risk?

Findings: In this cohort study, 1.8 million person-years of Medicare data revealed substantial variation in receipt of three or more concurrent fracture-associated drugs, among LTC residents; areas with greater use of fracture-associated drugs experienced higher risk-adjusted fracture rates.

Meaning: Guidelines to reduce fracture-associated drug use in LTC settings could decrease fractures in this vulnerable population.

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Emeny, R.T., Batsis, J.A. & Morden, N.E. Regional Variation in Fracture-Associated Prescription Drug Use and Hip Fractures in Long-Term Care: an Observational Study. J GEN INTERN MED (2021).

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