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Osteoporosis management among residents living in long-term care

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Abstract

Summary

Fractures in long-term care (LTC) residents have substantial economic and human costs. Osteoporosis management in residents with fractures or osteoporosis is low, and certain subgroups are less likely to receive therapy, e.g., those with >5 comorbidities, dementia, and wheelchair use. Many LTC residents who are at risk of fracture are not receiving optimal osteoporosis management.

Introduction

The objective of this study was to describe the prevalence and predictors of osteoporosis management among LTC residents with osteoporosis or fractures.

Methods

In a retrospective study, LTC residents of 17 facilities in Ontario and Manitoba, Canada were investigated. The participants were 65+ years old with osteoporosis, history of hip fracture, or recent fracture. Comprehensive assessments were conducted by trained nurse assessors between June 2005 and June 2006 using a standardized instrument, known as the Resident Assessment Instrument 2.0.

Results

Among residents (n = 525) with osteoporosis or fractures, 177 (34%) had had a recent fall. Bisphosphonate use was reported in 199 (38%) residents, calcitonin use in six (1%), and raloxifene use in six (1%). Calcium and vitamin D supplementation were reported in 140 (27%) residents. Fifty-four (10.3%) residents were on a bisphosphonate but were not taking vitamin D or multivitamin. Variables negatively associated with osteoporosis therapy [OR (95% CI)]: six or more comorbidities [0.46 (0.28–0.77), p = 0.028], wheelchair use [0.62 (0.40–0.95), p = 0.003], cognitive impairment [0.71 (0.55–0.92), p = 0.009], depression [0.54 (0.34–0.87), p = 0.01], swallowing difficulties [0.99 (0.988–0.999), p = 0.034] or Manitoba residence [0.47 (0.28–0.78), p = 0.004]. Prescription of 10+ medications was positively associated with therapy [3.34 (2.32–4.84), p < 0.001].

Conclusion

Osteoporosis management is not optimal among residents at risk of future fracture. Identifying at-risk subgroups of residents that are not receiving therapy may facilitate closing the osteoporosis care gap.

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Acknowledgements

This study was an environmental scan conducted in association with the Ontario Osteoporosis Strategy and received funding from the Ontario Ministry of Health and Long-Term Care and McMaster University. Dr. Maxwell is funded by a New Investigator Award from the Canadian Institutes of Health Research—Institute on Aging and a Health Scholar Award from the Alberta Heritage Foundation for Medical Research. Dr. Hirdes is the Ontario Home Care Research and Knowledge Exchange Chair. Dr. Papaioannou holds the CIHR/Eli Lilly Research Chair in Osteoporosis, Falls and Fracture Prevention.

Conflicts of interest

L. Giangregorio

I have been a co-investigator on a research grant supported by Merck Frosst.

A. Papaioannou

I am or have been a consultant or on the speaker’s bureau for the following: Aventis Pharma, Eli Lilly Canada Inc., Merck Frosst Canada, Novartis Pharmaceticals Canada Inc., Proctor and Gamble Pharmaceuticals.

M. Jantzi, J. Hirdes, C. Maxwell, J. Poss

No disclosures.

Author information

Authors and Affiliations

  1. Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada

    L. M. Giangregorio

  2. Toronto Rehabilitation Institute, Toronto, ON, Canada

    L. M. Giangregorio

  3. Department of Kinesiology, McMaster University, Hamilton, ON, Canada

    L. M. Giangregorio

  4. Department of Health Studies and Gerontology, University of Waterloo, Waterloo, ON, Canada

    M. Jantzi, J. Hirdes & J. W. Poss

  5. Department of Medicine, McMaster University, Hamilton, ON, Canada

    A. Papaioannou

  6. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

    A. Papaioannou

  7. Homewood Research Institute, Waterloo, ON, Canada

    J. Hirdes

  8. Departments of Community Health Sciences and Medicine, University of Calgary, Calgary, AB, Canada

    C. J. Maxwell

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  1. L. M. Giangregorio
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Correspondence to L. M. Giangregorio.

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Giangregorio, L.M., Jantzi, M., Papaioannou, A. et al. Osteoporosis management among residents living in long-term care. Osteoporos Int 20, 1471–1478 (2009). https://doi.org/10.1007/s00198-009-0837-x

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