Antihypertensive Medication Use Linked to Increased Fracture Risk in Nursing Home Residents With Dementia

In a recent study published in JAMA Internal Medicine, researchers found that the risk of fractures was numerically higher among subgroups of residents with dementia, higher baseline blood pressure values, and recent antihypertensive medication use.

The retrospective cohort study analyzed data from 29,648 long-term care nursing home residents within the Veterans Health Administration (VA) from January 1, 2006, to October 31, 2019. The researchers utilized a target trial emulation approach to assess the association between antihypertensive medication initiation and fracture risk.

The key findings of the study revealed that among the propensity score-matched cohort of 64,710 residents, those initiating antihypertensive medication experienced a significantly higher incidence rate of fractures per 100 person-years compared to the control group.


Additionally, the study found an increased risk of severe falls requiring hospitalizations or emergency department visits among those initiating antihypertensive therapy.

These findings underscore the importance of caution and additional monitoring when initiating antihypertensive medication in this vulnerable population, researchers said.

“This risk could be further exacerbated in this subgroup during anti-hypertensive medication initiation due to poorer reporting of subjective symptoms associated with orthostasis and falls,” researchers wrote.


Researchers also noted that among older nursing home residents, hip fractures alone have been associated with mortality rates exceeding 40% within a year.
“Fracture prevention is crucial in this population from a clinical and public health perspective, and commonly prescribed medications, such as antihypertensive medications, represent a prominent modifiable risk factor,” researchers wrote. “Nursing home facilities already implement high vigilance and preventive measures against falls and fractures; however, despite these existing guardrails, patients initiating antihypertensive medication had a higher risk of fractures and falls.”