Substantial regional variation exists in fracture-associated drug prescriptions for long-term care facility residents, a new study has found. And areas with greater use of these drugs experience higher hip fracture rates, investigators say.

The researchers analyzed Medicare data and prescription records of more than 420,000 long-term care residents, comparing clinical fracture-associated drug use across hospital referral regions. More than 36,000 hip fractures occurred between 2006 to 2014. And there was an average difference of 12% in the range of fracture-linked drug prescribing between regions, they found.

Residents in the highest-intensity prescribing regions had a 14% higher risk of fracture than residents in regions with the lowest-intensity prescribing, reported lead author Rebecca Emeny, Ph.D., MPH, of the Dartmouth Geisel School of Medicine, New Hampshire.

“Seeing such variation in the intensity of prescribing of these risky drugs across this vulnerable population adds to the evidence that guidelines aren’t necessarily being followed,” Emeny said.

Regions with the greatest fracture-associated drug prescription intensity (at least three prescribed) were in the southeast, including Gulfport and Oxford, MS; Alexandria and Monroe, LA; and Miami. The lowest intensity areas were in the Bronx, NY; Bend, OR; Albuquerque, NM; Honolulu; and Sun City, AR.

Many common prescription drugs, including opioid painkillers, sleep aids, diuretics, antidepressants and antacids, can raise fracture risk by increasing falls, weakening bones, or both. Medicare beneficiaries who take three or more of these drugs have a four-fold risk of hip fracture, Emeny and team discovered in a prior study. And long-term care residents’ exposure the drugs is almost twice that of people living in community settings, they said.

Full findings were published in the Journal of General Internal Medicine.