OBJECTIVE To systematically review medication-related risk factors for falls in older adults， to provide references for ensuring medication safety among older adults. METHODS A systematic search was conducted in PubMed， Embase， Web of Science， and CNKI for relevant literature published from database inception to November 1， 2025. Relevant studies on medication-related falls in older adults， both domestic and international， were included. Drug factors influencing falls in older adults were summarized and analyzed. RESULTS A total of 22 studies were included. Four major classes of fall-risk-increasing drugs were identified： psychotropic medications [12 studies， odds ratio （OR） range 1.500-5.790]， cardiovascular system drugs （5 studies， OR range 1.236-4.784）， analgesics （3 studies， OR range 1.500-4.490）， and hypoglycemic agents （3 studies， OR range 2.070-2.751）. Additionally， anticholinergic burden （1 study， OR was 2.610） and polypharmacy （7 studies， OR range 2.902-25.897 for the use of ≥4 medications） were identified as significant risk factors for falls. CONCLUSIONS Falls in older adults are significantly associated with psychotropic medications， cardiovascular system drugs， analgesics， and hypoglycemic agents， among which psychotropic medications pose the highest risk. Anticholinergic burden and polypharmacy are also important risk factors. In clinical practice， interventions should be implemented through deprescribing and risk monitoring to effectively reduce the risk of falls in older adults.

Objective To explore the role and mechanism of the exosomes derived from bronchoalveolar lavage fluid(BALF)of patients with chronic obstructive pulmonary disease(COPD-Exo)in regulating osteoblast differentiation.Methods A total of 6 COPD patients and 6 non-COPD patients admitted in our hospital in June 2023 were recruited,and their BALF samples were collected during the process.COPD-Exo and exosomes from the non-COPD patients(Ctrl-Exo)were extracted and identified by electron microscopy and Western blotting.Alizarin red staining and qRT-PCR were used to detect the differences in osteoblast differentiation after COPD-Exo and Ctrl-Exo intervention.Bioinformatics analysis was performed on the microRNA(miRNA)expression profiles of COPD-Exo and Ctrl-Exo in the GEO database(GSE218571)to obtain differentially expressed miRNAs.Antagomir was used to block mircoRNA function,and the miRNAs with osteogenic differentiation regulatory function were identified.Targetscan software was used to predict the downstream target genes of the miRNAs,and then these miRNAs were verified.Results Exo could be extracted from BALF of both COPD and non-COPD patients.Alizarin red staining and qRT-PCR results showed that COPD-Exo inhibited the osteogenic differentiation of human hFOB 1.19 osteoblasts(P＜0.05).Bioinformatics analysis indicated that the expression level of miR-223-3p was significantly up-regulated in COPD-Exo.Blocking miR-223-3p with Antagomir could alleviate the osteogenic differentiation of human hFOB 1.19 osteoblasts inhibited by COPD-Exo(P＜0.05).Targetscan prediction revealed that miR-223-3p may target and inhibit the expression of osteogenic differentiation-related factor FOXO3(P＜0.05).Conclusion COPD-Exo can inhibit the osteogenic differentiation of human hFOB 1.19 osteoblasts through miR-223-3p,which may be related to the inhibition of FOXO3 expression by miR-223-3p.