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Patterns of oral bisphosphonate deprescribing in older nursing home residents with dementia

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Abstract

Summary

In a national sample of Medicare nursing home residents with dementia treated with bisphosphonates, 20% had bisphosphonates deprescribed. Residents with clinical characteristics representing decreased likelihood for long-term benefit were more likely to have bisphosphonates deprescribed. Future studies are needed to evaluate outcomes of deprescribing bisphosphonates in this population.

Introduction

To determine incidence of deprescribing bisphosphonates among nursing home (NH) residents with dementia and identify factors associated with deprescribing.

Methods

2015–2016 Medicare claims, Part D prescriptions, Minimum Data Set (MDS) 3.0, and Nursing Home Compare for non-skilled NH residents aged 65 + with dementia and prescriptions for oral bisphosphonates overlapping the first 14 days of the stay. Our primary definition for deprescribing was a 90-day gap in medication supply; we also explored the reliability of different deprescribing definitions (30-, 90-, 180-day gaps). We estimated associations of NH, provider, and resident characteristics with deprescribing bisphosphonates using competing risks regression models.

Results

Most NH residents with dementia treated with bisphosphonates (n = 5312) were ≥ 80 years old (72%), white (81%), and female (90%); about half were dependent for transfers (50%) or mobility (45%). Using a 90-day gap in supply, the 180-day cumulative incidence of deprescribing bisphosphonates was 14.8%. This increased to 32.1% using a 30-day gap and decreased to 11.7% using a 180-day gap. Factors associated with increased likelihood for bisphosphonate deprescribing were age ≥ 90 years, newly admitted (vs. prevalent stay), dependent for mobility, swallowing difficulty, > 1 hospitalization in the prior year, CCRC facility, and nurse practitioner primary provider (vs. physician). Cancer and western geographic region were associated with reduced likelihood for deprescribing.

Conclusion

In a national sample of NH residents with dementia, bisphosphonate deprescribing was uncommon, and associated with clinical characteristics signifying poor prognosis and decreased likelihood for long-term benefit. Future studies should evaluate clinical outcomes of deprescribing bisphosphonates in this population.

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Acknowledgements

Funding sources had no role in the study design, data collection and analysis, manuscript preparation, or the decision to submit the manuscript for publication.

Funding

US Deprescribing Research Network/National Intsitutes on Aging (1R24AG064025). The Patrick and Catherine Weldon Donaghue Medical Research Foundation. Dr. Hanson is supported by the NIA/NIH under Award Number U54AG063546, which funds NIA Imbedded Pragmatic Alzheimer’s Disease and AD-Related Dementias Clinical Trials Collaboratory (NIA IMPACT Collaboratory).

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Authors and Affiliations

  1. Division of Geriatric Medicine, Center for Aging and Health, School of Medicine, University of North Carolina At Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA

    Joshua D. Niznik, Laura C. Hanson, Meredith A. Gilliam & Casey J. Kelley

  2. Division of Pharmaceutical Outcomes and Policy, University of North Carolina At Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA

    Joshua D. Niznik, Xintong Li & Carolyn T. Thorpe

  3. Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Joshua D. Niznik, Sherrie L. Aspinall & Carolyn T. Thorpe

  4. VA Center for Medication Safety, Hines, IL, USA

    Sherrie L. Aspinall

  5. University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA

    Sherrie L. Aspinall

  6. Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK

    Xintong Li

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  1. Joshua D. Niznik
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  4. Meredith A. Gilliam
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  7. Carolyn T. Thorpe
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Contributions

Study concept and survey design: J. Niznik and C. Thorpe. Data management and cleaning: J. Niznik, X. Li, and C. Thorpe. Statistical analysis and interpretation: J. Niznik, X. Li, C. Kelley, and C. Thorpe. Clinical perspective: J. Niznik, S. Aspinall, L. Hanson, and M. Gilliam. Preparation of manuscript: J. Niznik, S. Aspinall, L. Hanson, M. Gilliam, and C. Thorpe. Critical revision and feedback: J. Niznik, S. Aspinall, L. Hanson, M. Gilliam, X. Li, C. Kelley, and C. Thorpe. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Joshua D. Niznik.

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This study was deemed exempt by the University of North Carolina at Chapel Hill Institutional Review Board.

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Conflicts of interest

Dr. Joshua Niznik, Dr. Sherrie Aspinall, Dr. Laura Hanson, Dr. Meredith Gilliam, Xintong Li, Casey Kelley, and Dr. Carolyn Thorpe declare that they have no conflicts of interest to disclose.

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Niznik, J.D., Aspinall, S.L., Hanson, L.C. et al. Patterns of oral bisphosphonate deprescribing in older nursing home residents with dementia. Osteoporos Int 33, 379–390 (2022). https://doi.org/10.1007/s00198-021-06141-9

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  • DOI: https://doi.org/10.1007/s00198-021-06141-9

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