Low bone mineral density measurements in care home residents--a treatable cause of fractures.
OBJECTIVE
to assess predictors of fracture risk and treatment for osteoporosis among elderly care home residents.


METHODS



METHODS
cross-sectional survey;


METHODS
residents of care homes in Newcastle upon Tyne, UK;


METHODS
representative sample from residential care (87), nursing homes (105) and specialist homes for elderly people with dementia [elderly mentally infirm (EMI)]: residential (124) and nursing (76);


METHODS
dual-energy X-ray absorptiometry bone mineral density (BMD) at calcaneum; functional assessments, including cognition, using Mini-Mental State Examination (MMSE), Clifton Assessment Procedure for the Elderly-Behaviour Rating Score (CAPE-BRS) and Functional Assessment Staging Test (FAST) scores; current drug prescription.


RESULTS
MMSE, CAPE, FAST (all ANOVA P < 0.001) and weight (ANOVA P < 0.02) were lower in EMI homes. Drugs with sedative effects (chi-square, P < 0.0001) were more likely and calcium and vitamin D (CaD) supplementation (chi-square, P < 0.02) less likely in EMI care. For residential care, the odds ratio (OR) for sedative drugs in EMI was 2.13 (95% CI 1.11-4.06) with no significant difference between nursing homes. For CaD supplementation, the OR for EMI nursing homes was 0.19 (95% CI 0.05-0.72) and for EMI residential homes 0.38 (NS to 95% CI 0.12-1.27). BMD was low: mean T-score was -2.29 (95% CI -2-48 to -2.09) and Z-score -0.96 (95% CI -1.16 to -0.76) with a prevalence of osteoporosis (T-score < -1.6) of 69.2%. MMSE and FAST scores did not predict BMD. In EMI residential care, a decrease of CAPE score by 5 points was associated with a decrease in T-score by 0.6 (95% CI 0.15-1.1).


CONCLUSIONS
of the tools used to assess function, only CAPE predicted low BMD in EMI residential care. Rates of CaD supplementation are particularly low in EMI care, where risk factors for fracture were the greatest. We conclude that fracture risk is neglected in these homes, and targeted education and treatment are warranted.
Aspray
Terry J
TJ
Department of Geriatric Medicine, Institute for Ageing and Health, Newcastle General Hospital, Newcastle upon Tyne, UK. t.j.aspray@newcastle.ac.uk
Stevenson
Pamela
P
Abdy
Sharon E
SE
Rawlings
David J
DJ
Holland
Tom
T
Francis
Roger M
RM
D015502:Absorptiometry, Photon; D000369:Aged, 80 and over; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D010024:Osteoporosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D012112:Residential Facilities; D012307:Risk Factors
D050071:Bone Density Conservation Agents