OBJECTIVES:  The study evaluated the risk of falls and fractures associated with use of risperidone, olanzapine and quetiapine among community-dwelling older adults in the US METHODS: The study involved a multiple propensity score-adjusted retrospective cohort design and included older adults aged 50 years and above, who initiated prescriptions of risperidone, olanzapine or quetiapine between July 1, 2000 and June 30, 2008 using IMS LifeLink Health Plans Claims database. Patients were followed until hospitalization/emergency room (ER) visit for accidental fall/hip fracture, or the end of the study period, whichever occurred earlier. Propensity score-adjusted Cox proportional hazard regression model was used to evaluate the relative risk of falls or fractures. The covariates in the final model included maximum dose of antipsychotic therapy, and exposure to other psychotropic medications that increase the risk of falls or fractures. RESULTS: There were 12,145 (5,083 risperidone, 4,377 olanzapine and 2,685 quetiapine) new users of atypical agents.  A total of 380 cases of falls or fractures with at least one hospitalization/ ER visit following the use of antipsychotic agents were identified. The number of falls or fractures for risperidone, olanzapine and quetiapine were 165 (3.65%), 109 (2.81%) and 106 (4.47%) respectively. After adjusting for propensity scores and other covariates, the Cox proportional hazard model showed that there was no statistically significant difference with use of risperidone (hazard ratio, HR-1.11; 95% CI- 0.85-1.45) or quetiapine (HR-1.16; CI-0.87-1.53) compared to olanzapine in the risk of falls or fractures. CONCLUSIONS: The study found no significant difference across the individual atypical agents in the risk of falls or fractures in a large cohort of older adults. Future studies are required to evaluate the overall safety profiles of atypical antipsychotics in the above population.