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Blood pressure medications linked to increased fracture risk
Last reviewed: 02.07.2025
A Rutgers Health study found that high blood pressure medications more than doubled the risk of life-threatening bone fractures in nearly 30,000 nursing home patients.
The authors of the study, published in JAMA Internal Medicine, say the increased risk is because the drugs impair balance, especially when patients first stand up and temporarily experience low blood pressure, which deprives the brain of oxygen. Interactions with other medications and the low baseline balance of many nursing home patients compound the problem.
"Bone fractures often trigger a downward spiral in nursing home patients. About 40 percent of those who break a hip die within the next year, so it's really alarming to find that a class of drugs used by 70 percent of all nursing home residents more than doubles the risk of bone fractures," said Chintan Dave, academic director of the Rutgers Center for Health Outcomes, Policy, and Economics and lead author of the study.
While many patients have high blood pressure so high that the benefits of treatment outweigh the risks, "those patients require close monitoring, especially early in treatment, and that's not happening," Dave said. "Nursing home staff view blood pressure medications as very low risk, and that's not true for this group of patients."
Dave’s team analyzed Veterans Health Administration data for 29,648 older patients in long-term care facilities from 2006 to 2019. The researchers compared the 30-day risk of hip, pelvic, humerus, radius, or ulna fractures in patients who started using blood pressure medications with similar patients who did not. To maximize the likelihood that medication use, rather than some other factor, was driving the different outcomes, they adjusted for more than 50 baseline covariates, such as patient demographics and clinical history.
The 30-day risk of fracture for residents who started taking blood pressure medication was 5.4 per 100 person-years, compared with 2.2 per 100 person-years for patients who did not take blood pressure medications.
Further analysis showed that medication use particularly increased fracture risk in certain subgroups. Patients with dementia, systolic blood pressure above 139 (the first number in the blood pressure reading), diastolic blood pressure above 79 (the second number), or no recent use of blood pressure medications had at least a threefold increased risk of fracture compared with non-medical patients.
About 2.5 million Americans live in nursing homes or assisted living facilities. Up to 50 percent of them fall in a year, and up to 25 percent of those falls result in serious injury.
A Rutgers Health study shows that blood pressure medications cause many of these falls, and a combination of less medication and better support could significantly reduce the problem.
"Staff can't properly assess the balance of risk and benefit unless they have accurate information about the risks," Dave said. "I hope this study will give them information to help them better serve their patients."