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National trends in osteoporosis medication use among Medicare beneficiaries with and without Alzheimer’s disease/related dementias

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Abstract

Background

Osteoporotic fractures  are a leading cause of disability and premature death in the elderly. Patients with Alzheimer’s and related dementia (ADRD) have high rates of osteoporosis (OP) and substantial risk of osteoporotic fractures. Yet research is sparse on trends and predictors of OP medication use in ADRD.

Methods

Medicare beneficiaries with OP aged ≥ 67 years have Medicare parts A/B/D without HMO from 2016 to 2018. Our outcome was receipt of OP medications in 2018. A multivariable logistic regression assessed association between ADRD and OP drug prescribing, adjusted for age, sex, race, region, Medicare entitlement, dual Medicaid eligibility, chronic conditions, number of provider visits/hospitalizations, and nursing home (NH) resident status. Age/ADRD and NH residency/ADRD interactions were tested.

Results

Our sample consisted of 47,871 people with OP and ADRD and 201,840 with OP without ADRD. OP drug use was 38.6% in ADRD patients vs. 52.7% in non-ADRD. After adjustment for demographics, chronic conditions, and previous hospitalizations/physician visits, the OR for OP drug in ADRD vs. non-ADRD was 0.85 (95% CI: 0.83–0.87). NH residents had lower odds for OP medication (OR: 0.61, 95% CI: 0.58–0.64). There were significant interactions between ADRD and age, and between ADRD and NH residency. The OR for OP drug use associated with ADRD was 0.88 (95% CI: 0.86–0.90) among community-dwelling elders and 0.66 (95% CI: 0.64–0.69) among NH residents.

Conclusions

ADRD patients received OP drugs at a lower rate than their non-ADRD counterparts. More research is needed on when to prescribe or deprescribe OP drugs in the context of different ADRD severity, patient preferences, remaining life expectancy, and time-to-benefit from OP drugs.

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References

  1. Office of the Surgeon General (US). Bone health and osteoporosis: a report of the surgeon general. Rockville (MD): Office of the Surgeon General (US); 2004. Preface. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45521/

  2. Liara Rizzi, Idiane Rosset, Matheus Roriz-Cruz (2014) Global epidemiology of dementia: Alzheimer’s and vascular types. BioMed Res Int 908915:8, 2014. https://doi.org/10.1155/2014/908915

  3. Harris-Kojetin, Lauren D.;Sengupta, Manisha;Lendon, Jessica Penn;Rome, Vincent;Valverde, Roberto;Caffrey, Christine; Corporate Authors(s) : National Center for Health Statistics (U.S.) Published Date : February 2019 Series : Vital and health statistics. Series 3, analytical and epidemiological studies; no 43;DHHS publication ; no. 2019–1427; URL : https://stacks.cdc.gov/view/cdc/76253 {FIX}

  4. Harris-Kojetin L, Sengupta M, Lendon JP, Rome V, Valverde R, Caffrey C (2019) Long-term care providers and services users in the United States, 2015–2016. National Center for Health Statistics. Vital Health Stat 3(43). https://doi.org/10.1002/alz.12328

  5. Sarah D. Berry, Yoojin Lee, Andrew R. Zullo, Doug P. Kiel, David Dosa, Vincent Mor (2016) Incidence of hip fracture in U.S. nursing homes. J Gerontol: Series A 71(9):1230–1234. https://doi.org/10.1093/gerona/glw034

  6. Tu KN, Lie JD, Wan C, Cameron M, Austel AG, Nguyen JK, Van K, Hyun D (2018) Osteoporosis: a review of treatment options. P & T : a peer-reviewed journal for formulary management 43(2):92–104

    Google Scholar 

  7. Colón-Emeric C, Lyles KW, Levine DA et al (2007) Prevalence and predictors of osteoporosis treatment in nursing home residents with known osteoporosis or recent fracture. Osteoporos Int 18:553–559. https://doi.org/10.1007/s00198-006-0260-5

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  9. Mughal et al. Osteoporosis in patients with dementia is associated with high morbidity and mortality AJGP VOL. 48, NO. 1–2, JAN–FEB 2019. https://www1.racgp.org.au/ajgp/2019/january%E2%80%93february/osteoporosis-in-patients-with-dementia

  10. Gleason LJ, Menzies IB, Mendelson DA, Kates SL, Friedman SM (2012) Diagnosis and treatment of osteoporosis in high-risk patients prior to hip fracture. Geriatr Orthop Surg Rehabil 3(2):79–83. https://doi.org/10.1177/2151458512454878

    Article  PubMed  PubMed Central  Google Scholar 

  11. Blume SW, Curtis JR (2011) Medical costs of osteoporosis in the elderly Medicare population. Osteoporos Int 22(6):1835–1844. https://doi.org/10.1007/S00198-010-1419-7

    Article  CAS  PubMed  Google Scholar 

  12. Chronic conditions. Chronic Conditions Data Warehouse. (n.d.). Retrieved July 25, 2022, from https://www2.ccwdata.org/web/guest/condition-categories-chronic

  13. Other chronic health, mental health, and potentially disabling conditions. Chronic Conditions Data Warehouse. (n.d.). Retrieved July 25, 2022, from https://www2.ccwdata.org/web/guest/condition-categories-other

  14. Gupta G, Aronow WS (2003) Underuse of procedures for diagnosing osteoporosis and of therapies for osteoporosis in older nursing home residents. J Am Med Dir Assoc 4(4):200–202. https://doi.org/10.1097/01.JAM.0000073963.49915.FC

    Article  PubMed  Google Scholar 

  15. Parikh S, Mogun H, Avorn J, Solomon DH (2008) Osteoporosis medication use in nursing home patients with fractures in 1 US state. Arch Intern Med 168(10):1111–1115. https://doi.org/10.1001/archinte.168.10.1111

    Article  PubMed  Google Scholar 

  16. Silvia Deandrea, Francesca Bravi, Federica Turati, Ersilia Lucenteforte, Carlo La Vecchia, Eva Negri (2013) Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis. Arch Gerontol Geriatr 56(3):407–415, ISSN 0167–4943. https://doi.org/10.1016/j.archger.2012.12.006

  17. Tinetti ME, Bogardus ST Jr, Agostini JV (2004) Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med 351(27):2870–2874. https://doi.org/10.1056/NEJMsb042458

    Article  CAS  PubMed  Google Scholar 

  18. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW (2005) Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 294(6):716–724. https://doi.org/10.1001/jama.294.6.716

    Article  CAS  PubMed  Google Scholar 

  19. Curtis JR, Safford MM (2012) Management of osteoporosis among the elderly with other chronic medical conditions. Drugs Aging 29(7):549–564. https://doi.org/10.2165/11599620-000000000-00000

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Gleason LJ, Menzies IB, Mendelson DA, Kates SL, Friedman SM (2012) Diagnosis and treatment of osteoporosis in high-risk patients prior to hip fracture. Geriatr Orthop Surg Rehabil 3(2):79–83. https://doi.org/10.1177/2151458512454878

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gosch M, Jeske M, Kammerlander C, Roth T (2012) Osteoporosis and polypharmacy. Z Gerontol Geriatr 45(6):450–454. https://doi.org/10.1007/s00391-012-0374-7

    Article  CAS  PubMed  Google Scholar 

  22. Lindsay J, Dooley M, Martin J et al (2015) The development and evaluation of an oncological palliative care deprescribing guideline: the ‘OncPal deprescribing guideline.’ Support Care Cancer 23:71–78

    Article  PubMed  Google Scholar 

  23. Holmes HM, Todd A (2017) The role of patient preferences in deprescribing. Clin Geriatr Med 33(2):165–175. https://doi.org/10.1016/j.cger.2017.01.004

    Article  PubMed  Google Scholar 

  24. Niznik JD, Li X, Gilliam MA, Hanson LC, Aspinall SL, Colon-Emeric C, Thorpe CT (2021) Are nursing home residents with dementia appropriately treated for fracture prevention? J Am Med Dir Assoc 22(1):28–35.e3. https://doi.org/10.1016/j.jamda.2020.11.019

  25. Ibrahim K, Cox NJ, Stevenson JM, Lim S, Fraser SDS, Roberts HC (2021) A systematic review of the evidence for deprescribing interventions among older people living with frailty. BMC Geriatr 21(1):258. https://doi.org/10.1186/s12877-021-02208-8

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

Drs. Kuo and Raji are funded by the grant R01DA039192 from the National Institute on Drug Abuse.

Mrs. Armstrong is supported by the 2022 National Institute on Aging-Sponsored Medical Student Training in Aging Research (MSTAR) program.

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Authors and Affiliations

  1. John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA

    Peyton Armstrong, Yong-Fang Kuo, Peter Cram & Mukaila A. Raji

  2. School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA

    Yong-Fang Kuo, Jordan Westra & Mukaila A. Raji

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  1. Peyton Armstrong
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Armstrong, P., Kuo, YF., Cram, P. et al. National trends in osteoporosis medication use among Medicare beneficiaries with and without Alzheimer’s disease/related dementias. Osteoporos Int 34, 725–733 (2023). https://doi.org/10.1007/s00198-023-06680-3

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