OBJECTIVES: A preexisting fracture is a very strong predictor of subsequent osteoporotic fractures, emphasizing the need to aggressively treat patients with existing osteoporotic fractures. The objectives of the study are to examine the prevalence of drug treatment and factors associated with drug treatment among elderly nursing home (NH) admissions with an indication of osteoporotic fracture. METHODS: The Minimum Data Set for Nursing Home Assessment and Care Screening (MDS) Version 2.0 and physicians' medication orders from 1999 were utilized for this study. The outcome was the use of anti-osteoporotic drug therapy at NH admission. Independent variables included patient demographics, comorbidities, functional capabilities (activities of daily living or ADLs), and cognitive performance (MDS-COGS). Multivariate analysis was conducted using logistic regression with Generalized Estimating Equations (GEE) to adjust for clustering within NH facilities.RESULTS: A total of 2,673 NH residents were identified with documentation of osteoporotic fracture within 180 days or affecting current care at admission; however, only 642 (24.02%) received anti-osteoporotic drug therapy at admission. Gender (p<0.0001), age (p=0.0394), and functional capabilities (p=0.0002) were significantly associated with the use of anti-osteoporotic drug. Non-significant factors were region, race, education, comorbidity and cognition. Treatment was less likely for male residents (OR: 0.45; 95% CI, 0.33-0.62) and residents older than 85 (OR: 0.79; 95% CI, 0.67-0.97). Those who were independent in terms of ADLs were more likely to receive drug treatment (OR: 2.54; 95% CI,1.27-5.07), compared to those who were fully dependent. CONCLUSIONS: While osteoporotic fracture is common among the NH elderly population, the majority remained untreated. Increasing age was inversely related to receipt of anti-osteoporotic drugs. Female elderly and those with fewer limitations in daily activities were more likely to receive drug therapy for osteoporosis.