Osteoporosis Medication Use in Nursing Home Patients With Fractures in 1 US State

Abstract

Background: Little is known about osteoporosis medication use among high-risk patients in nursing homes (NHs). We studied the patterns and predictors of osteoporosis medication use in elderly patients who sustained a fracture and were admitted to an NH. Methods: We linked pharmaceutical claims data from 2 state-run drug assistance programs for elderly patients to Medicare data for the years 1995 through 2004. We defined the rates of osteoporosis medication use among patients admitted to an NH following a hip, wrist, or humeral fracture for the 12-month period after the fracture. Predictors of using an osteoporosis medication were assessed in a multivariate Cox proportional hazards model adjusting for age and sex. Results: Of the 4430 eligible postfracture patients, only 11.5% were prescribed an osteoporosis medication. There was a progressive increase in use from 1.6% in 1995 to 18.7% in 2001 but no increases in 2001 through 2004. Patient characteristics associated with osteoporosis medication use included a history of osteoporosis medication use in the prior 12 months (hazard ratio, 19.5; 95% confidence interval, 16.0-23.7) and female sex (hazard ratio, 1.57; 95% confidence interval, 1.13-2.21). A history of falls or fracture was not a significant factor. Calcitonin was the most commonly used osteoporosis medication (56%). Conclusions: While the rate of osteoporosis medication use increased across the 10-year period, a low rate of osteoporosis medication use persists in the NH setting. More appropriate use of drug treatment of highrisk patients is needed in NHs.

Osteoporosis management among residents living in long-term care

“…The findings are of particular interest as these individuals are at high risk of falls and fractures [2]; 34% had experienced a fall in the last 180 days and 16% of fallers experienced a fracture. The findings of an osteoporosis care gap in LTC residents in Canada are consistent similar studies in the USA [20,21], with research conducted among home care recipients [15], and community-living individuals with fragility fractures in Canada [14] and internationally [13].…”

“…The proportion of residents with osteoporosis or fracture history in the current study who were receiving medication (40%) is comparable to that reported in a recent American study (37%) [20], but higher than that reported in another similar American study (11.5%) [21], which likely reflects the timing of data collection (2005-2006 vs. 2003-2004 and 1995-2004 in the American studies, respectively). Bisphosphonates were the most commonly reported osteoporosis medications in the current study.…”

“…Similarly, a study evaluating both dietary and supplemental sources reported that only 26% and 30% of individuals living in LTC had adequate intake of calcium and vitamin D, respectively [18]. Two recent studies have reported that osteoporosis management (e.g., use of bisphosphonates, calcitonin or calcium, and vitamin D) is poor among LTC residents in the USA with a history of fracture and/or diagnosis of osteoporosis [20,21]. The purpose of the present study is to describe the extent to which institutionalized individuals in Canada with a history of recent fracture or diagnosis of osteoporosis are receiving osteoporosis management and to identify sociodemographic, clinical, and functional characteristics associated with osteoporosis management.…”

Osteoporosis Prescribing in Long-Term Care: Impact of a Provincial Knowledge Translation Strategy

“…Pharmacologic therapy is indicated for patients at (1) high absolute fracture risk (> 20% probability over 10 years) based on risk tools Leslie et al, 2011a) and (2) individuals over age 50 with a hip or vertebral fracture or more than one fragility fracture (Papaioannou et al, 2010b). Several studies in Ontario (Giangregorio et al, 2009;Ioannidis et al, 2012a) and other regions (Colon-Emeric et al, 2007b;Jachna, Shireman, Whittle, Ellerbeck, & Rigler, 2005;Kamel, 2007;Parikh, Avorn, & Solomon, 2009;Parikh, Mogun, Avorn, & Solomon, 2008;Wright, 2007) have demonstrated that the management of osteoporosis and fractures is sub-optimal in LTC residents.In 2007, at the outset of the Ontario Osteoporosis Strategy for LTC, we conducted an environmental scan to examine the prescribing of vitamin D, calcium, and osteoporosis medications in a convenience sample of 10 Ontario LTC homes. In 2012, we had access to prescribing records and facility characteristics for a large, unselected cohort of Ontario LTC homes (n = 166).…”

“…For example, despite the publication and dissemination of Canadian osteoporosis guidelines in 2002 (Brown & Josse, 2002), a considerable osteoporosis care gap remained in both community-dwelling and institutionalized cohorts (Leslie et al, 2012;Giangregorio, 2006;Papaioannou et al, 2004;2008). Similarly, the benefits of calcium and vitamin D for LTC residents have been well known since Chapuy et al's (1992) widely cited publication, yet little uptake in their use occurred in the decade after the study was published (Kamel, 2007;Parikh et al, 2008;Rojas-Fernandez, Lapane, MacKnight, & Howard, 2002).Considerable knowledge translation efforts are required to make substantial improvements in health care practices. As Grol (2010) suggested:…”