Are Nursing Home Residents With Dementia Appropriately Treated for Fracture Prevention?

This was an observational claims study, so it cannot show that any factor caused prescribing or that treatment prevented fractures. The medication window included the year before assessment and 90 days after it, so it may count prescriptions that were not continued and may measure some resident characteristics after treatment. The study could not see goals of care, why clinicians chose or stopped medication, or whether low treatment was thoughtful deprescribing. Over-the-counter calcium and vitamin D were not captured. Bedbound residents could not be identified from the MDS. Skilled nursing facility stays were excluded because medication administration data were unavailable. Fracture risk was based on prior fracture or FRAiL score, not bone density.

The authors reported no conflicts of interest. Funding sources had no role in the study design, data collection and analysis, manuscript preparation, or decision to publish.

Do not read the 11.6% treatment rate as proof that most high-risk residents were undertreated. The study reports prescribing patterns, not fracture outcomes, and cannot tell whether treatment was appropriate, omitted, or deliberately stopped for goals of care.