Abstract
Summary
We studied nursing home residents with osteoporosis or recent fracture to determine the frequency and predictors of osteoporosis treatment. There was wide variation in performance, and both clinical and systems variables predicted use. This study shows that improvement in osteoporosis care is possible and important for many nursing homes.
Introduction
We determined the prevalence and predictors of osteoporosis evaluation and treatment in high-risk nursing home residents.
Methods
We identified 67 nursing facilities in North Carolina and Arizona with > 10 residents with osteoporosis or recent hip fracture. Medical records (n = 895) were abstracted for osteoporosis evaluation [dual-energy X-ray absorptiometry (DXA), vitamin D level, serum calcium), treatment (calcium, vitamin D, osteoporosis medication, hip protectors), clinical, and systems covariates. Data were analyzed at the facility level using mixed models to account for the complex nesting of residents within providers and nursing facilities.
Results
Calcium and vitamin D was prescribed for 69% of residents, bisphosphonates for 19%, calcitonin for 14%, other pharmacologic therapies for 6%, and hip protectors for 2%. Overall, 36% received any bone protection (medication or hip protectors), with wide variation among facilities (0–85%). Factors significantly associated with any bone protection included female gender [odds ratio (OR) 2.4, (1.5–3.7)] and nonurban/suburban location [1.5, (1.1–2.2)]. Residents with esophagitis, peptic ulcer disease (PUD), or dysphagia [0.6, (0.4–0.9)] and alcohol abuse [0.2, (0.0–0.9)] were less likely to receive treatment.
Conclusions
There is substantial variation in the quality of osteoporosis treatment across nursing homes. Interventions that improve osteoporosis quality of care are needed.
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Funding and acknowledgements
Supported by the Alliance for Bone Health, and the Center for Education and Research on Therapeutics of Musculoskeletal Disorders AHRQ 3U18HS10389-06S1. Dr. Colón-Emeric is supported by a Paul A. Beeson award K23 AG024787. The analyses upon which this publication is based were performed under Contract Number 500-02-AZ02 AZ0020, funded by the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. Publication No. AZ-8SOW-SS-061206-01.
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Colón-Emeric, C., Lyles, K.W., Levine, D.A. et al. Prevalence and predictors of osteoporosis treatment in nursing home residents with known osteoporosis or recent fracture. Osteoporos Int 18, 553–559 (2007). https://doi.org/10.1007/s00198-006-0260-5
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DOI: https://doi.org/10.1007/s00198-006-0260-5