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Robert B. Wallace, MD, MSc

JAMA. 2000;284:1018-1019.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Among the more than 1.5 million Americans who live in nursing homes,¹ most are older than 65 years and, by standard national definitions, receive intermediate and skilled care. Many have dementia, incontinence, and physical disabilities, as well as major chronic illnesses such as heart disease, cancer, degenerative arthritis, stroke, and other neurological conditions. As a few studies have demonstrated,^2-3 low bone mineral density (BMD) and osteoporosis are highly prevalent in this population. Prevalence rates for osteoporosis, as defined by World Health Organization criteria, have been reported in up to 80% to 85% of these individuals: that is, BMD levels at various anatomic sites, particularly the femoral neck, at least 2.5 SDs below the mean for young adults.⁴

Thus, in this setting of frailty, disability, and morbidity, it is not surprising that fracture rates among nursing home residents are much higher than in equivalent, community-dwelling demographic . . . [Full Text of this Article]

Author Affiliation: University of Iowa College of Public Health, Iowa City.

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