Osteoporosis Medication Use in Long-Term Care Residents with Fractures

Researchers at the Harvard Medical School recently published the results of an exploratory study that examined osteoporosis medication use among high-risk patients living in long-term care (LTC) communities. The goal of this study was to explore the patterns and predictors of medication use in older adult patients who sustained a fracture and were admitted into a LTC community. They discovered that few patients, upon entering a long-term care community because of a fracture, receive osteoporosis medications.

Osteoporosis has been reported to be highly prevalent in LTC communities. Up to 80% of LTC residents are reportedly diagnosable with osteoporosis.

The authors of this study linked pharmaceutical claims data in one state from two state-run drug assistance programs to Medicare data for the years 1995 to 2004. They tabulated the rates of osteoporosis medication use among patients admitted to a nursing LTC community following a hip, wrist, or humeral fracture for the 12-month period after the fracture.
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They found that only 11.5% of the patients in this dataset had received osteoporosis drugs over a 10-year period. The rate of medication usage increased from 1.5% in 1995 to 18.7% in 2001, but did not increase for the remainder of the study (up to 2004). Calcitonin was the most commonly prescribed medication, followed by bisphosphonates, estrogen-containing hormone therapy, and Raloxifene. During the study period, the use of Calcitonin declined, while bisphosphonates increased.

The only two significant predictors of medication usage were a history of usage in the 12 months prior to admittance and being female. This relationship between gender and medication prescription became stronger when examining only those cases that were new prescriptions.

The fact that very few patient characteristics helped to explain medication usage in LTC communities suggests that physician practice in this area is highly variable and deserving of further study.

Source: Parikh, S., Mogun, H., Avorn, J., Solomon, D.H. 2008. Osteoporosis medication use in nursing home patients with fractures in 1 U.S. State. Archives of Internal Medicine 168(10):1111-1115.