The research team, led by Dr. Tingting Zhang (pictured), used national data to identify all long-stay nursing center residents aged 65 years or older who were enrolled in Medicare during a specific time period (2008 and 2009). They then examined incidence rates for hip fracture by race through 2013. Hip fracture rates were highest among Native American and white residents; these groups were more likely to receive drugs that could increase hip fracture risk through their effects on falls. In particular, Native Americans received opioids most frequently. Native Americans were also more likely to have diabetes. There were no significant differences in quality measures among centers housing Native Americans, although they were more likely to be rural and for-profit.

According to the research team, this study is noteworthy for presenting data for Native Americans, an understudied population that is often included under “other” race, and for including demographic, functional, and clinical risk factors. Effective fracture prevention strategies for Native American residents may include medication review for drugs associated with greater fall risk and for opioids.