Zullo AR, et al. - In this retrospective cohort study performed in nursing homes (NHs) in the United States, researchers examined frail long-stay NH residents (65 years or older) initiating treatment with a bisphosphonate (N = 17,753) for osteoporosis, to determine the predictors of hip fracture unique to these individuals. They compared estimates between bisphosphonate initiators and calcitonin initiators (control group; N = 5,348). In the study sample, 85% were women, and 51% had moderate to severe cognitive impairment. A higher risk of hip fracture despite bisphosphonate treatment was predicted by age 75 years or older to 85 years (vs ≥ 65 to < 75 y), female gender, white race, and body mass index = 18.5-24.9 (vs ≥ 30). Also, two significant predictors were independent ability to transfer (vs total dependence) and occasional urinary incontinence (vs frequent). New users of bisphosphonates vs calcitonin did not have different predictors of hip fracture. Since no risk factors unique to bisphosphonate users were identified, therefore, the inclusion of existing nonpharmacologic therapies, especially fall prevention strategies, in fracture prevention efforts was recommended.