Are Nursing Home Residents With Dementia Appropriately Treated for Fracture Prevention?

Niznik, Joshua D.; Li, Xintong; Gilliam, M.; Hanson, Laura C.; Aspinall, Sherrie L.; Colón‐Emeric, Cathleen; Thorpe, Carolyn T.

doi:10.1016/j.jamda.2020.11.019

Cited by 13 publications

(9 citation statements)

References 37 publications

(34 reference statements)

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“…Furthermore, Hispanic or Asian patients were more likely to receive treatment than White patients (Table 1), similar to trends observed in the Medicare Part D patient population, (22) as well a recent study on fracture prevention for nursing home patients with dementia. (23) Anabolic medications were more often prescribed to younger patients. Patients on anabolic medications were also more likely to be White, have higher educational status, and have higher net worth (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…At the present time, the geographical distribution of romosozumab prescriptions is mostly limited to Western states (Nevada and Montana), as well as Iowa and a select few Southeastern states (Florida, Georgia, and Alabama), which is also consistent with a recent study on fracture prevention for nursing home patients with dementia. (23) Not surprisingly, the top four types of providers who prescribe anabolic medications are rheumatologists, endocrinologists, general internists, and family practitioners, ie, osteoporosis specialists and primary care providers. This trend indicates that it is important for providers who often interact with this patient population, such as orthopedic and neurological surgeons, to collaborate with these specialists to optimize treatment and long-term follow-up of osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

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Anabolic and Antiresorptive Osteoporosis Treatment: Trends, Costs, and Sequence in a Commercially Insured Population, 2003–2021

Wadhwa

Lee

et al. 2023

JBMR Plus

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New anabolic medications (abaloparatide and romosozumab) were recently approved for osteoporosis, and data suggest that prescribing antiresorptive medications after a course of anabolic medications offers better outcomes. This study aimed to characterize prescription trends, demographics, geographical distributions, out‐of‐pocket costs, and treatment sequences for anabolic and antiresorptive osteoporosis medications. Using a commercial claims database (Clinformatics Data Mart), adult patients with osteoporosis from 2003 to 2021 were retrospectively reviewed and stratified based on osteoporosis medication class. Patient demographics and socioeconomic variables, provider types, and out‐of‐pocket costs were collected. Multivariable regression analyses were used to identify independent predictors of receiving osteoporosis treatment. A total of 2,988,826 patients with osteoporosis were identified; 616,635 (20.6%) received treatment. Patients who were female, Hispanic or Asian, in the Western US, had higher net worth, or had greater comorbidity burden were more likely to receive osteoporosis medications. Among patients who received medication, 31,112 (5.0%) received anabolic medication; these were more likely to be younger, White patients with higher education level, net worth, and greater comorbidity burden. Providers who prescribed the most anabolic medications were rheumatologists (18.5%), endocrinologists (16.8%), and general internists (15.3%). Osteoporosis medication prescriptions increased fourfold from 2003 to 2020, whereas anabolic medication prescriptions did not increase at this rate. Median out‐of‐pocket costs were $17 higher for anabolic than antiresorptive medications, though costs for anabolic medications decreased significantly from 2003 to 2020 (compound annual growth rate: −0.6%). A total of 8388 (1.4%) patients tried two or more osteoporosis medications, and 0.6% followed the optimal treatment sequence. Prescription of anabolic osteoporosis medications has not kept pace with overall osteoporosis treatment, and there are socioeconomic disparities in anabolic medication prescription, potentially driven by higher median out‐of‐pocket costs. Although prescribing antiresorptive medications after a course of anabolic medications offers better outcomes, this treatment sequence occurred in only 0.6% of the study cohort. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anabolic and Antiresorptive Osteoporosis Treatment: Trends, Costs, and Sequence in a Commercially Insured Population, 2003–2021

Wadhwa

Lee

et al. 2023

JBMR Plus

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“…Prior observational studies report treatment for osteoporosis is as low as 12%–19% among NH residents at risk for fracture 15,28 . Another cross‐sectional study found that one‐third of NH residents with the diagnosis of osteoporosis receive treatment 29 .…”

Section: Discussionmentioning

confidence: 99%

“…Prior observational studies report treatment for osteoporosis is as low as 12%-19% among NH residents at risk for fracture. 15,28 Another cross-sectional study found that one-third of NH residents with the diagnosis of osteoporosis receive treatment. 29 FLS have been shown to achieve high rates of osteoporosis treatment and adherence in community-dwellers, 30,31 Additional investigation is needed to determine whether this model improves the quality of shared decision-making and osteoporosis treatment rates in the NH setting.…”

Section: Discussionmentioning

confidence: 99%

Nursing Home PRevention of Injury in DEmentia (NH PRIDE): A pilot study of a remote injury prevention service for NH residents

Berry,

Hecker,

McConnell

et al. 2023

J American Geriatrics Society

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BackgroundMedication optimization, including prescription of osteoporosis medications and deprescribing medications associated with falls, may reduce injurious falls. Our objective was to describe a remote, injury prevention service (NH PRIDE) designed to optimize medication use in nursing homes (NHs), and to describe its implementation outcomes in a pilot study.MethodsThis was a non‐randomized trial (pilot study) including NH staff and residents from five facilities. Long‐stay residents at high‐risk for injurious falls were identified using a validated risk calculator and staff referral. A remote team reviewed the electronic health record (EHR) and provided recommendations as Injury Prevention Plans (IPP). A research nurse served as a care coordinator focused on resident engagement and shared decision‐making. Outcomes included implementation measures, as identified in the EHR, and surveys and interviews with staff.ResultsAcross five facilities, 274 residents were screened for eligibility, and 46 residents (16.8%) were enrolled. Most residents were female (73.9%) and had dementia (63.0%). An IPP was completed for 45 residents (97.8%). The nurse made a total of 93 deprescribing recommendations in 36 residents (80% of residents had one or more deprescribing recommendation; mean 2.2 recommendations/resident). Twenty of 45 residents (44.4%) had a recommendation for osteoporosis treatment. Among residents with recommendations, 21/36 (58.3%) had one or more deprescribing orders written and 6/20 (30.0%) had an osteoporosis medication prescribed. At 4 months, most medication changes persisted. Adverse side effects were rare. Staff members identified several areas for program refinement, including aligning recommendations with provider workflow and engaging consultant psychiatrists.ConclusionsA remote injury prevention service is safe and feasible to enhance deprescribing and osteoporosis treatment in long‐stay NH residents at risk for injury. Additional investigation is needed to determine if this model could reduce injurious falls when deployed across NH chains.

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“…A wide body of evidence supports the use of vitamin D, calcium, and antiresorptive therapies, with safety and effectiveness demonstrated for aged care residents [ 4 ]. Despite this, osteoporosis management is sub-optimal amongst the aged care population [ 5 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Osteoporosis management in Australian aged care facilities: a mixed method study

Laird,

Williams,

Benson

2024

Arch Osteoporos

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Summary Osteoporosis is a common but sub-optimally managed disease amongst aged care residents. Pharmacists undertaking comprehensive medication reviews is one strategy to improve osteoporosis management. Analysis of pharmacist medication review recommendations has identified common clinical practice issues that can be addressed to optimise osteoporosis management for aged care residents. Purpose This study investigates the prevalence of osteoporosis medicine use amongst Australian aged care residents and explores drug-related problems (DRPs) identified during medication reviews and pharmacist recommendations to resolve them. Methods Resident demographics, medications, diagnoses, osteoporosis related DRPs, and recommendations to resolve them were extracted from medication review reports. A mixed methods approach was taken to analysis, involving descriptive statistical analysis and content analysis. Results Medication review reports relating to 980 residents were collected. Antiresorptive therapies were used by 21.7% of residents, of which 87.2% were prescribed denosumab. Osteoporosis related DRPs represented 14.0% of all DRPs identified by pharmacists. Vitamin D was involved in 55.4% of these DRPs, the remainder concerned antiresorptive therapies (23.4%), medications contributing to osteoporosis (16.3%), and calcium (4.9%). Frequent deviations in practice from aged care clinical guidelines and consensus recommendations concerning vitamin D and calcium were found. DRPs and accompanying recommendations relating to denosumab revealed inadequate monitoring and inadvertent therapy disruptions. Conclusion Pharmacist identified DRPs and recommendations revealed common aspects of clinical practice that can be addressed to improve osteoporosis management for aged care residents. A need to raise awareness of aged care-specific consensus recommendations concerning vitamin D and calcium is evident. Facility protocols and procedures must be developed and implemented to ensure safe and effective use of denosumab.

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Are Nursing Home Residents With Dementia Appropriately Treated for Fracture Prevention?

Cited by 13 publications

References 37 publications

Anabolic and Antiresorptive Osteoporosis Treatment: Trends, Costs, and Sequence in a Commercially Insured Population, 2003–2021

Anabolic and Antiresorptive Osteoporosis Treatment: Trends, Costs, and Sequence in a Commercially Insured Population, 2003–2021

Nursing Home PRevention of Injury in DEmentia (NH PRIDE): A pilot study of a remote injury prevention service for NH residents

Osteoporosis management in Australian aged care facilities: a mixed method study

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