We have analyzed the history of institutional fractures in 153 men, age 48 to 96, 86% white, who had resided in this VA nursing home for an average of 6.3 years as of August 1984. At that time, we reviewed their medical charts to record the numbers and sites of fractures which had been diagnosed during the preceding 1 to 5 years of nursing home residence, the duration of this period depending on the duration of institutionalization. Fractures during the period of nursing home residence under review had occurred in 24 of the 153 men; 6 residents had experienced two or more fractures. Fracture rates during institutionalization in hip, spine, and wrist were 2,564, 366, and 549/100,000 patient years, respectively. The incidence at all sites was 5,861/100,000 patient years. These rates were 5 to 11 times higher than the figures previously reported in the age-matched general population of white men in the United States, England, or Finland. The nursing home men who had experienced fractures at any site were significantly (nondirectional P less than 0.02) older than those who had not experienced any fracture. The hip fracture group, however, did not differ significantly (P greater than 0.05) in age from the no fracture group.