Considerable pharmacologic undertreatment for the prevention of osteoporosis was reported among residents of nursing homes with a history of recent falls and fractures, and dependency when walking, according to study results published in Maturitas. However, overtreatment was observed among residents with high mortality in whom preventive pharmacotherapy may not have been appropriate.
Researchers sought to evaluate the prevalence of pharmacologic osteoporosis prevention among nursing home residents and its association with patient characteristics. Cross-sectional analyses of data from the Services and Health for Elderly in Long Term Care (SHELTER) study was conducted among nursing home residents from the Czech Republic, England, Finland, France, Germany, Italy, the Netherlands, and Israel. Researchers examined the overall frequency of osteoporosis medication use (vitamin D, calcium, and bisphosphonates) in residents who were stratified for fractures and falls in the previous 30 days, dependence when walking, cognitive impairment, and health instability with a high risk for mortality.
Of a total of 3832 nursing home residents eligible in the study, vitamin D, calcium, and bisphosphonates were used by 16.2%, 10.4%, and 4.5% of participants, respectively. When all 3 classes of osteoporosis medications were grouped together, they were used by 1.5% of participants. Among residents who had sustained a recent fracture, 9.5% received a bisphosphonate and 2.7% received all 3 osteoporosis medications. Among residents who had experienced a recent fall, 20.8% received vitamin D and 15.3% received calcium.
In addition, among participants with severe cognitive impairment, 15.5% received vitamin D and 9.3% received calcium. Among bisphosphonate users, 33.7% also received both vitamin D and calcium, 25.8% received only calcium in addition to the bisphosphonate, and 17.4% received only vitamin D in addition to the bisphosphonate.
Of note, the use of osteoporosis medications varied widely across the 8 countries — from 66.8% in Finnish nursing home residents to 3.0% in Israeli nursing home residents. Possible overtreatment was observed among residents with a high mortality risk, in whom the use of preventive pharmacotherapy may not have been appropriate.
Study limitations included the analysis of data from several years ago and the lack of generalizability to participants from other countries.
Researchers concluded that efforts are needed to improve the use of pharmacotherapy among nursing home residents.
Makan AM, van Hout H, Onder G, et al. Pharmacological management of osteoporosis in nursing home residents; the Shelter study. Maturitas. Published online October 31, 2020. doi:10.1016/j.maturitas.2020.10.020