To the Editor I read with interest the article by Dave et al1 and the related Invited Commentary by Canales and Shorr,2 both of which relate to a large and methodologically rigorous observational analysis from the Veterans Health Administration assessing the association between antihypertensive medication initiation and risk of fracture in a propensity score鈭抦atched cohort of 64鈥�710 nursing home residents. The study found a 2-fold greater risk of fracture associated with blood pressure (BP) medication initiation. Increased risk was also observed among those with dementia, with elevated baseline systolic (鈮�140 mm Hg) or diastolic (鈮�80 mm Hg) BP, and who were antihypertensive naive.