Hip fracture rates among long-stay residents in nursing facilities rose slightly after dipping in 2013, even as fewer seniors fell in community settings.

Investigators documented a climb between 2013 and 2015 and a post-fracture mortality rate of about 42% in 2014. Survivors were likely to suffer infections and pressure ulcers, leading to functional decline and diminished quality of life.

“In general, nursing home residents are older and sicker, with more cognitive and functional impairment than community-dwellers,” reported lead author Sarah D. Berry, M.D., MPH, of Harvard Medical School. “One possible explanation for these high rates is the underutilization of medications to treat osteoporosis.”

A separate study in the journal Bone points to diabetes as a possible culprit. Researchers at England’s University of Sheffield found patients with type 1 and type 2 diabetes are more likely to suffer hip and nonvertebral fractures. Insulin use and longer diabetes duration contribute to the increased risk.

The researchers called for increased awareness and routine assessments for bone density and bone strength as part of diabetes care.