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Diagnosis and treatment of osteoporosis before and after admission to long-term care institutions

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Abstract

Summary

Bisphosphonate treatment rates were examined before and after admission to long-term residential care. Bisphosphonate treatment rates were low (16%) pre-admission but doubled after long-term residential care admission (30%). Men were very undertreated for osteoporosis, while a history of falls with injury was not associated with treatment.

Introduction

To determine the rates and independent correlates of bisphosphonate treatment in elderly residents before and after admission to long-term care (LTC) institutions.

Methods

Information was collected from records of 421 residents of four LTC institutions in Edmonton, Alberta, Canada. Osteoporosis-related diagnoses, treatments, and risk factors including falls in LTC and any adulthood fractures were abstracted. Osteoporosis was defined by physician diagnosis or documented fractures of the hip, spine, or upper extremity. Multivariable analyses were undertaken to determine factors independently associated with bisphosphonate treatment.

Results

Mean age was 84 ± 8 years and 290 (70%) were female. Overall, 142 (34%) had previous fractures, 170 (41%) had physician-diagnosed osteoporosis, and 227 (54%) residents met the study’s clinical definition of osteoporosis. Of those with osteoporosis, 44 (19%) were men. Before admission, 36 (16%) patients with osteoporosis were treated with bisphosphonates; after admission another 31 (14%) were started on bisphosphonates by LTC physicians. Women were far more likely than men to start bisphosphonate treatment [30 (97%) women vs. 1 (3%) man, adjusted odds ratio (aOR) = 9.20 (95% confidence intervals 1.2,70.5)]. Falls with injury were common [72/227 (31%)] but not associated with bisphosphonate treatment (adjusted p value > 0.5).

Conclusion

Rates of pre-admission bisphosphonate treatment were low, but did double after LTC admission. Women were almost ten times more likely to start bisphosphonate treatment than men, although one fifth of those with documented osteoporosis were men. Although falls cause most fractures, a history of falls with injury was not associated with bisphosphonate treatment. Our findings suggest that targeting men and residents with falls for treatment with bisphosphonates might be warranted.

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Acknowledgment

We would like to thank the Capital Care Group for allowing access to their medical and pharmacy records to perform our review. We would also like to acknowledge the very constructive and careful reviews undertaken by anonymous peer reviewers that permitted us to make substantial improvements to this work.

Conflicts of interest

This study was supported by an unrestricted research grant from Aventis Canada. Dr. Beaupre receives salary support from Alberta Innovates Health Solutions (formerly Alberta Heritage Foundation for Medical Research) as a Population Health Investigator. Dr. Majumdar receives salary support from the Alberta Innovates Health Solutions (formerly Alberta Heritage Foundation for Medical Research) as a health scholar. Dr. Morrish has received unrestricted educational grants from Sanofi-Aventis Canada and honoraria for membership on advisory boards for Amgen Canada and Novartis Canada. He also has advisory board memberships for Genzyme Canada and AstraZeneca. The other authors have no financial disclosures or conflicts of interest.

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Authors and Affiliations

  1. Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada

    L. A. Beaupre

  2. Department of Surgery, University of Alberta, Edmonton, Alberta, Canada

    L. A. Beaupre & S. Dieleman

  3. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

    S. R. Majumdar, A. Au & D. W. Morrish

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  1. L. A. Beaupre
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  2. S. R. Majumdar
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Correspondence to L. A. Beaupre.

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Beaupre, L.A., Majumdar, S.R., Dieleman, S. et al. Diagnosis and treatment of osteoporosis before and after admission to long-term care institutions. Osteoporos Int 23, 573–580 (2012). https://doi.org/10.1007/s00198-011-1582-5

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