Prevalence and predictors of osteoporosis treatment in nursing home residents with known osteoporosis or recent fracture.
CONCLUSIONS
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.


BACKGROUND
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.
Colón-Emeric
C
C
Duke University Center for Aging and Human Development, and the Durham VA GRECC, Erwin Rd, Durham, NC 27710, USA. colon001@mc.duke.edu
Lyles
K W
KW
Levine
D A
DA
House
P
P
Schenck
A
A
Gorospe
J
J
Fermazin
M
M
Oliver
K
K
Alison
J
J
Weisman
N
N
Xie
A
A
Curtis
J R
JR
Saag
K
K
D000368:Aged; D000369:Aged, 80 and over; D001130:Arizona / Q000453:epidemiology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002116:Calcitonin / Q000627:therapeutic use; D002136:Calcium, Dietary / Q000008:administration & dosage; D002140:California / Q000453:epidemiology; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000517:prevention & control; D006615:Hip; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010024:Osteoporosis / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000628:therapy; D015995:Prevalence; D011482:Protective Devices; D011787:Quality of Health Care; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage
D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D004164:Diphosphonates; D014807:Vitamin D; D002116:Calcitonin