OBJECTIVES: To estimate the odds ratio of hip or vertebral fracture associated with oral anti-spasticity medications in a California Medicaid stroke/spasticity population. METHODS: A case-control design matched each hip or vertebral fracture patient to five patients without fracture on date of first prescription of oral spasticity medication. Oral spasticity medications were grouped according to their sedative qualities (light headedness, somnolence or drowsiness). Logistic regression was used to estimate adjusted odds ratios of fractures for medication groups while controlling for patient demographics, comorbidity, and other concurrent medications, through a propensity score approach. RESULTS: The adjusted odds ratio of having a hip or vertebral fracture for patients using medication classified in the somnolence group (Dronabinol, Lamotrigine, Riluzole or Tizanidine) was 1.88 (p = 0.003). The odds ratio was reduced to 1.65 after propensity score adjustment, but remained statistically significant (p = 0.024). Light headedness and drowsiness medication groups did not show a significant effect on fracture. Concurrent use of Diazepam, a member of the drowsiness medication group, was individually associated with the likelihood of fracture (raw odds ratio = 1.48, p = 0.002; odds ratio after propensity score adjustment = 1.39, p = 0.014). CONCLUSIONS: Care should be taken when prescribing sedating oral spasticity agents in elderly stroke patients.