Treatment for osteoporosis in Australian residential aged care facilities: consensus recommendations for fracture prevention

Duque, Gustavo; Close, Jacqueline C.T.; J, Jäger; Ebeling, Peter R.; Inderjeeth, Charles; Lord, Stephen R.; McLachlan, Andrew J.; Reid, Ian R.; Troen, Bruce R.; Sambrook, Philip N.

doi:10.5694/j.1326-5377.2010.tb03839.x

Cited by 22 publications

(20 citation statements)

References 56 publications

(63 reference statements)

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“…These data are based on patients’ self-reporting and thus it is difficult to draw any firm conclusions. However, the finding could strengthen the impression that the recommended supplement dose of vitamin D in Norway (400 IE vitamin D 3 ) is not enough to maintain an adequate level of vitamin D in elderly individuals, and several authors have recommended 800–1000 IE vitamin D 3 as a daily supplement for the elderly [6,55,56]. …”

Section: Discussionmentioning

confidence: 99%

Vitamin D deficiency is common in psychogeriatric patients, independent of diagnosis

et al. 2014

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BackgroundPrevious studies have found an association between psychiatric disorders and vitamin D deficiency, but most studies have focused on depression. This study aimed to establish the prevalence of vitamin D deficiency in elderly patients with a wider range of psychiatric diagnoses.MethodThe study included elderly patients (>64 years) referred to a psychiatric hospital in Northern Norway and a control group from a population survey in the same area. An assessment of psychiatric and cognitive symptoms and diagnoses was conducted using the Montgomery and Aasberg Depression Rating Scale, the Cornell Scale for Depression in Dementia, the Mini Mental State Examination, the Clockdrawing Test, and the Mini International Neuropsychiatric Interview (MINI+), as well as clinical interviews and a review of medical records. The patients’ mean level of 25-hydroxyvitamin D (25(OH)D) and the prevalence of vitamin D deficiency were compared with those of a control group, and a comparison of vitamin D deficiency across different diagnostic groups was also made. Vitamin D deficiency was defined as 25(OH)D <50 nmol/L (<20 ng/ml).ResultsThe mean levels of 25(OH)D in the patient group (n = 95) and the control group (n = 104) were 40.5 nmol/L and 65.9 nmol/L (p < 0.001), respectively. A high prevalence of vitamin D deficiency was found in the patient group compared with the control group (71.6% and 20.0%, respectively; p < 0.001). After adjusting for age, gender, season, body mass index, and smoking, vitamin D deficiency was still associated with patient status (OR: 12.95, CI (95%): 6.03-27.83, p < 0.001). No significant differences in the prevalence of vitamin D deficiency were found between patients with different categories of psychiatric diagnoses, such as depression, bipolar disorders, psychosis, and dementia.ConclusionVitamin D deficiency is very common among psychogeriatric patients, independent of diagnostic category. Even though the role of vitamin D in psychiatric disorders is still not clear, we suggest screening for vitamin D deficiency in this patient group due to the importance of vitamin D for overall health.

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Section: Discussionmentioning

confidence: 99%

Vitamin D deficiency is common in psychogeriatric patients, independent of diagnosis

et al. 2014

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“…A scoping review of strategies for the prevention of hip fractures in elderly nursing home residents documented that vitamin D supplementation and, in some cases, alendronate and hip protectors were associated with reduced fracture risk [26]. Consensus recommendations for fracture prevention in LTC have been published [27,28]; however, most recommendations are based on data obtained in clinical trials that excluded LTC residents, which may reduce physicians’ confidence in applying them [29]. Recently Rondondi et al demonstrated that in an older population of LTC residents the 10-year fracture probability appeared to be mainly determined by age and clinical risk factors obtained by medical history, rather than by BMD or the presence of vertebral fractures on radiography [30], thereby supporting the concept that prediction rules in LTC may not necessitate evaluation of BMD or imaging.…”

Section: Discussionmentioning

confidence: 99%

Fracture risk assessment in long-term care:a survey of long-term care physicians

et al. 2013

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BackgroundThe majority of frail elderly who live in long-term care (LTC) are not treated for osteoporosis despite their high risk for fragility fractures. Clinical Practice Guidelines for the diagnosis and management of osteoporosis provide guidance for the management of individuals 50 years and older at risk for fractures, however, they cannot benefit LTC residents if physicians perceive barriers to their application. Our objectives are to explore current practices to fracture risk assessment by LTC physicians and describe barriers to applying the recently published Osteoporosis Canada practice guidelines for fracture assessment and prevention in LTC.MethodsA cross-sectional survey was conducted with the Ontario Long-Term Care Physicians Association using an online questionnaire. The survey included questions that addressed members’ attitudes, knowledge, and behaviour with respect to fracture risk assessment in LTC. Closed-ended responses were analyzed using descriptive statistics and thematic framework analysis for open-ended responses.ResultsWe contacted 347 LTC physicians; 25% submitted completed surveys (81% men, mean age 60 (Standard Deviation [SD] 11) years, average 32 [SD 11] years in practice). Of the surveyed physicians, 87% considered prevention of fragility fractures to be important, but a minority (34%) reported using validated fracture risk assessment tools, while 33% did not use any. Clinical risk factors recommended by the OC guidelines for assessing fracture risk considered applicable included; glucocorticoid use (99%), fall history (93%), age (92%), and fracture history (91%). Recommended clinical measurements considered applicable included: weight (84%), thyroid-stimulating hormone (78%) and creatinine (73%) measurements, height (61%), and Get-Up-and-Go test (60%). Perceived barriers to assessing fracture risk included difficulty acquiring necessary information, lack of access to tests (bone mineral density, x-rays) or obtaining medical history; resource constraints, and a sentiment that assessing fracture risk is futile in this population because of short life expectancy and polypharmacy.ConclusionPerceived barriers to fracture risk assessment and osteoporosis management in LTC have not changed recently, contributing in part to the ongoing care gap in osteoporosis management. Our findings highlight the importance to adapt guidelines to be applicable to the LTC environment, and to develop partnerships with stakeholders to facilitate their use in clinical practice.

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“…Bisphosphonates (BPs) are drugs prescribed for the treatment and prevention of osteoporosis as well as skeletal metastases in patients suffering from malignant diseases because these drugs act as strong inhibitors of osteoclast‐mediated bone resorption (Duque et al., ; Mahtani & Jahanzeb, ). The two most potent and widely used nitrogen‐containing BPs are zoledronate or zoledronic acid (ZA) and alendronate (ALN).…”

Section: Introductionmentioning

confidence: 99%

Alteration of macrophage viability, differentiation, and function by bisphosphonates

Patntirapong

Poolgesorn

2018

Oral Diseases

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Treatment for osteoporosis in Australian residential aged care facilities: consensus recommendations for fracture prevention

Cited by 22 publications

References 56 publications

Vitamin D deficiency is common in psychogeriatric patients, independent of diagnosis

Vitamin D deficiency is common in psychogeriatric patients, independent of diagnosis

Fracture risk assessment in long-term care:a survey of long-term care physicians

Alteration of macrophage viability, differentiation, and function by bisphosphonates

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