The use of blood pressure drugs more than doubles the risk of life-threatening bone fractures in the elderly, a study conducted among nursing home residents revealed.

Approximately 2.5 million Americans live in nursing homes or assisted living facilities. Each year, nearly half of these residents experience falls, with up to 25 percent of the cases leading to serious injury.

"Bone fractures often start nursing home patients on a downward spiral. Roughly 40 percent of those who fracture a hip die within the next year, so it's truly alarming to find that a class of medications used by 70 percent of all nursing home residents more than doubles the bone-fracture risk," said Chintan Dave, lead author of the study, in a news release.

The research team used data from 29,648 elderly patients in long-term care facilities to compare their 30-day risk of fractures to the hip, pelvis, upper arm, radius, or forearm with the initiation of antihypertensive medication. The researchers compared the bone fracture risk in patients who started blood pressure medications with similar patients who did not take any blood pressure drugs.

To understand the specific impact of blood pressure drugs without the influence of other factors, the researchers adjusted for over 50 baseline variables, including patient demographics and clinical history.

"The 30-day fracture risk for residents who began blood pressure medication was 5.4 per 100 people per year and 2.2 per 100 people per year for patients who took no blood pressure medication," the news release stated.

The researchers noted that patients with dementia, those with systolic blood pressure above 139, people with diastolic blood pressure above 79, or those with no recent use of blood pressure medication, have at least triple the fracture risk.

The increased risk is attributed to the medications' tendency to impair balance. Impaired balance particularly affects patients when they initially stand up and experience low blood pressure. Since many of the nursing home residents are also on other drugs, interactions with these medications could cause a generally low baseline balance.

However, the use of blood pressure drugs benefits many people who have high enough blood pressure to outweigh the risks. "Such patients require careful observation, particularly when treatment begins, and that's not happening. Caregivers think of blood pressure medication as very low risk, and that's not true in this patient population," Dave said.

"Caregivers can't strike this right balance of risk and reward if they don't have accurate data about the risks. I hope this study gives them information that helps them serve their patients better," Dave added.

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