Osteoporosis International

, Volume 23, Issue 2, pp 573–580 | Cite as

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

  • L. A. Beaupre
  • S. R. Majumdar
  • S. Dieleman
  • A. Au
  • D. W. Morrish
Original Article

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.

Keywords

Bisphosphonates Falls Long-term care Osteoporosis 

References

  1. 1.
    Sallin U, Mellstrom D, Eggertsen R (2005) Osteoporosis in a nursing home, determined by the DEXA technique. Med Sci Monit 11:CR67–CR70PubMedGoogle Scholar
  2. 2.
    Cameron ID, Chen JS, March LM, Simpson JM, Cumming RG, Seibel MJ, Sambrook PN (2010) Hip fracture causes excess mortality owing to cardiovascular and infectious disease in institutionalized older people: a prospective 5-year study. J Bone Miner Res 25:866–872PubMedGoogle Scholar
  3. 3.
    Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152:380–390PubMedGoogle Scholar
  4. 4.
    Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P (2009) Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169, 145 cases during 1977–2001. J Bone Miner Res 24:1299–1307PubMedCrossRefGoogle Scholar
  5. 5.
    Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E (2001) Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int 12:271–278PubMedCrossRefGoogle Scholar
  6. 6.
    Leslie WD, O’Donnell S, Jean S, Lagace C, Walsh P, Bancej C, Morin S, Hanley DA, Papaioannou A (2009) Osteoporosis surveillance expert working group trends in hip fracture rates in Canada. JAMA 302:883–889PubMedCrossRefGoogle Scholar
  7. 7.
    Norton R, Campbell AJ, Reid IR, Butler M, Currie R, Robinson E, Gray H (1999) Residential status and risk of hip fracture. Age Ageing 28:135–139PubMedCrossRefGoogle Scholar
  8. 8.
    Visentin P, Ciravegna R, Uscello L, Molaschi M, Fabris F (1995) Site-specific relative risk of fractures in the institutionalized elderly. Gerontology 41:273–279PubMedCrossRefGoogle Scholar
  9. 9.
    Lyles KW, Schenck AP, Colon-Emeric CS (2008) Hip and other osteoporotic fractures increase the risk of subsequent fractures in nursing home residents. Osteoporos Int 19:1225–1233PubMedCrossRefGoogle Scholar
  10. 10.
    Berry SD, Samelson EJ, Bordes M, Broe K, Kiel DP (2009) Survival of aged nursing home residents with hip fracture. J Gerontol 64:771–777Google Scholar
  11. 11.
    Harris IA, Yong S, McEvoy L, Thorn L (2010) A prospective study of the effect of nursing home residency on mortality following hip fracture. ANZ J Surg 80:447–450PubMedCrossRefGoogle Scholar
  12. 12.
    Chandler JM, Zimmerman SI, Girman CJ, Martin AR, Hawkes W, Hebel JR, Sloane PD, Holder L, Magaziner J (2000) Low bone mineral density and risk of fracture in white female nursing home residents. JAMA 284:972–977PubMedCrossRefGoogle Scholar
  13. 13.
    Giangregorio LM, Jantzi M, Papaioannou A, Hirdes J, Maxwell CJ, Poss JW (2009) Osteoporosis management among residents living in long-term care. Osteoporos Int 20:1471–1478PubMedCrossRefGoogle Scholar
  14. 14.
    Colon-Emeric C, Lyles KW, Levine DA, House P, Schenck A, Gorospe J, Fermazin M, Oliver K, Alison J, Weisman N, Xie A, Curtis JR, Saag K (2007) Prevalence and predictors of osteoporosis treatment in nursing home residents with known osteoporosis or recent fracture. Osteoporos Int 18:553–559PubMedCrossRefGoogle Scholar
  15. 15.
    Jachna CM, Shireman TI, Whittle J, Ellerbeck EF, Rigler SK (2005) Differing patterns of antiresorptive pharmacotherapy in nursing facility residents and community dwellers. J Am Geriatr Soc 53:1275–1281PubMedCrossRefGoogle Scholar
  16. 16.
    Rojas-Fernandez CH, Lapane KL, MacKnight C, Howard KA (2002) Undertreatment of osteoporosis in residents of nursing homes: population-based study with use of the systematic assessment of geriatric drug use via epidemiology (SAGE) database. Endocr Pract 8:335–342PubMedGoogle Scholar
  17. 17.
    Wright RM (2007) Use of osteoporosis medications in older nursing facility residents. J Am Med Dir Assoc 8:453–457PubMedCrossRefGoogle Scholar
  18. 18.
    Beaupre LA, Cinats JG, Jones CA, Scharfenberger AV, William CJ, Senthilselvan A, Saunders LD (2007) Does functional recovery in elderly hip fracture patients differ between patients admitted from long-term care and the community? J Gerontol 62:1127–1133Google Scholar
  19. 19.
    Majumdar SR, Lier DA, Beaupre LA, Hanley DA, Maksymowych WP, Juby AG, Bell NR, Morrish DW (2009) Osteoporosis case manager for patients with hip fractures: results of a cost-effectiveness analysis conducted alongside a randomized trial. Arch Int Med 169:25–31CrossRefGoogle Scholar
  20. 20.
    Schousboe JT, Nyman JA, Kane RL, Ensrud KE (2005) Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women. Ann Intern Med 142:734–741PubMedGoogle Scholar
  21. 21.
    Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS, Goodman M, Smith DH, Platt R, Gurwitz JH (2003) Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 163:2052–2057PubMedCrossRefGoogle Scholar
  22. 22.
    Melton LJ III, Thamer M, Ray NF, Chan JK, Chesnut CH III, Einhorn TA, Johnston CC, Raisz LG, Silverman SL, Siris ES (1997) Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation. J Bone Miner Res 12:16–23PubMedCrossRefGoogle Scholar
  23. 23.
    Elliott ME, Binkley NC, Carnes M, Zimmerman DR, Petersen K, Knapp K, Behlke JM, Ahmann N, Kieser MA (2003) Fracture risks for women in long-term care: high prevalence of calcaneal osteoporosis and hypovitaminosis D. Pharmacotherapy 23:702–710PubMedCrossRefGoogle Scholar
  24. 24.
    Zimmerman SI, Girman CJ, Buie VC, Chandler J, Hawkes W, Martin A, Holder L, Hebel JR, Sloane PD, Magaziner J (1999) The prevalence of osteoporosis in nursing home residents. Osteoporos Int 9:151–157PubMedCrossRefGoogle Scholar
  25. 25.
    Paniagua MA, Malphurs JE, Samos LF (2006) BMI and low bone mass in an elderly male nursing home population. Clin Interv Aging 1:283–287PubMedCrossRefGoogle Scholar
  26. 26.
    Toofanny N, Maddens ME, Voytas J, Kowalski D (2004) Low bone mass and postfall fracture risk among elderly nursing home men. J Am Med Dir Assoc 5:367–370PubMedCrossRefGoogle Scholar
  27. 27.
    Curtis JR, McClure LA, Delzell E, Howard VJ, Orwoll E, Saag KG, Safford M, Howard G (2009) Population-based fracture risk assessment and osteoporosis treatment disparities by race and gender. J Gen Intern Med 24:956–962PubMedCrossRefGoogle Scholar
  28. 28.
    Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH (2002) Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med 162:2217–2222PubMedCrossRefGoogle Scholar
  29. 29.
    Nguyen TV, Eisman JA, Kelly PJ, Sambrook PN (1996) Risk factors for osteoporotic fractures in elderly men. Am J Epidemiol 144:255–263PubMedGoogle Scholar
  30. 30.
    Cawthon PM, Ewing SK, McCulloch CE, Ensrud KE, Cauley JA, Cummings SR, Orwoll ES (2009) Osteoporotic fractures in men (MrOS) research group. Loss of hip BMD in older men: the osteoporotic fractures in men (MrOS) study. J Bone Miner Res 24:1728–1735PubMedCrossRefGoogle Scholar
  31. 31.
    Endo Y, Aharonoff GB, Zuckerman JD, Egol KA, Koval KJ (2005) Gender differences in patients with hip fracture: a greater risk of morbidity and mortality in men. J Orthop Trauma 19:29–35PubMedCrossRefGoogle Scholar
  32. 32.
    Fransen M, Woodward M, Norton R, Robinson E, Butler M, Campbell AJ (2002) Excess mortality or institutionalization after hip fracture: men are at greater risk than women. J Am Geriatr Soc 50:685–690PubMedCrossRefGoogle Scholar
  33. 33.
    Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B (2010) Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 39:203–209PubMedCrossRefGoogle Scholar
  34. 34.
    Bolland MJ, Grey AB, Gamble GD, Reid IR (2010) Effect of osteoporosis treatment on mortality: a meta-analysis. J Clin Endocrinol Metab 95:1174–1181PubMedCrossRefGoogle Scholar
  35. 35.
    Beaupre LA, Morrish DW, Hanley DA, Maksymowych WP, Bell NR, Juby AG, Majumdar SR (2010) Oral bisphosphonates are associated with reduced mortality after hip fracture. Osteoporos Int. 05 Nov 2010 eprint ahead of printGoogle Scholar
  36. 36.
    Lyles KW, Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, Hyldstrup L, Recknor C, Nordsletten L, Moore KA, Lavecchia C, Zhang J, Mesenbrink P, Hodgson PK, Abrams K, Orloff JJ, Horowitz Z, Eriksen EF, Boonen S, HORIZON Recurrent FT (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. New Engl J Med 357:1799–1809PubMedCrossRefGoogle Scholar
  37. 37.
    Sambrook PN, Cameron ID, Chen JS, March LM, Simpson JM, Cumming RG, Seibel MJ (2010) Oral bisphosphonates are associated with reduced mortality in frail, older people: a prospective 5-year study. Osteopor Int. 01 Oct 2010 eprint ahead of publicationGoogle Scholar
  38. 38.
    Marks R, Allegrante JP, Ronald MC, Lane JM (2003) Hip fractures among the elderly: causes, consequences and control. Age Res Rev 2:57–93CrossRefGoogle Scholar
  39. 39.
    Palvanen M, Kannus P, Parkkari J, Pitkajarvi T, Pasanen M, Vuori I, Jarvinen M (2000) The injury mechanisms of osteoporotic upper extremity fractures among older adults: a controlled study of 287 consecutive patients and their 108 controls. Osteoporos Int 11:822–831PubMedCrossRefGoogle Scholar
  40. 40.
    Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35(Suppl 2):ii37–ii41PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • L. A. Beaupre
    • 1
    • 2
  • S. R. Majumdar
    • 3
  • S. Dieleman
    • 2
  • A. Au
    • 3
  • D. W. Morrish
    • 3
  1. 1.Department of Physical TherapyUniversity of AlbertaEdmontonCanada
  2. 2.Department of SurgeryUniversity of AlbertaEdmontonCanada
  3. 3.Department of MedicineUniversity of AlbertaEdmontonCanada

Personalised recommendations