In the United States 4% of men and 19% of older women have sustained a hip fracture: the clinical manifestation of osteoporosis. The rate of hip fractures among nursing home residents is 2 times higher than community-dwelling older adults. Fewer than half are treated with fracture prevention medications. The cost of treatment for hip fractures is 665 million dollars per year, from nursing home residents alone. Hip fractures are a large financial burden on the healthcare system and have a substantially increased risk of major morbidity and mortality in adults, especially in nursing home residents who may already have multi-morbidity. Approximately 50% of patients are unable to regain their prior level of function after a hip fracture and there is a 1-year mortality of 24%. Appropriate treatment for osteoporosis can decrease the risk of hip fracture. Short treatment durations are beneficial; 3 years of appropriate pharmacologic therapy has been demonstrated to reduce risk of fracture by 50%, with benefits seen as early as 1 year after initiation of treatment. Unfortunately, this is often not done in nursing homes despite being a vulnerable population.
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