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Osteoporosis management among residents living in long-term care

L.M. GiangregorioM. Jantzi

A.PapaioannouJ. Hirdes

C.J. MaxwellJ.W. Poss

Osteoporos Int 2009, 20:1471-1478.

Background

Fractures in long-term care (LTC) residents

have substantial economic and human costs.

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Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

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Describe the prevalence and predictors of osteoporosis management among long-term care facilities.

Identify sociodemographic, clinical and functional characteristics associated with osteoporosis management.

What are the objectives?

Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

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What methods were used?

• Retrospective study of 17 LTC facilities 13 in Ontario, 4 in Manitoba

• Used Resident Assessment Instrument RAI 2.0 data

• Residents were 65+ years

• Inclusion criteria for osteoporosis group: History of hip fracture Any fracture within past 180 days Diagnosis of osteoporosis Prescribed osteoporosis medication

Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

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Description of Osteoporosis Group

Characteristics (n = 525) mean or n (%)

Age in years: mean (SD) 86.2 (7.0)

Number of Females: n (%) 460 (87.6)

Osteoporosis Diagnosis: n (%) 292 (55.7)

Diagnosis of Hip Fracture: n (%) 181 (34.5)

Diagnosis of Other Fracture: n (%) 23 (4.4)

Fracture(s) within the last 180 days: n (%) 24 (4.6)

Fall(s) within the last 180 days: n (%) 177 (33.7)

Faller(s) who experienced a fracture: % 16%

Taking any osteoporosis medication: % 40%

Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

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What percentage of residents (n=525) received osteoporosis treatment?

Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

MORE likely to receive treatment if: Taking 10 or more medications

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What are predictors of osteoporosis management in LTC?

LESS likely to receive treatment if: Have 6+ co-morbid conditions Use a wheelchair Have cognitive impairment Have swallowing difficulties Depression From facility in Manitoba

Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

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Important considerations:10% of residents were taking a bisphosphonate but were

not taking vitamin D or a multivitamin

Possible reasons for suboptimal osteoporosis management: nonadherence tolerability length of treatment versus life expectancy or prognosis prevention of polypharmacy or less focus on preventative health

than on “presenting” conditions (Duque et al. J Am Med Dir Assoc 2007, 8, e67-e73)

What are the issues in LTCosteoporosis management?

Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

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Osteoporosis Management:

Is not optimal among residents at risk for future fracture

Needs to identify at-risk subgroups of residents that are not receiving therapy in order to close the osteoporosis care gap

What did we conclude?

Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

AcknowledgmentsThis 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

10Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.