To prevent osteoporotic fractures in nursing home residents a combination of bisphosphonates,
calcium and vitamin D is recommended. This study assessed the prevalence of pharmacological
osteoporosis prevention in nursing home residents from eight countries, and assessed
its association with patient characteristics.
Cross-sectional analyses of the SHELTER study data. We assessed the overall prevalence
of osteoporosis medication (OM) use (vitamin D, calcium and bisphosphonates) in residents
stratified for falls and fractures over last 30 days, health instability with high
mortality risk, cognitive impairment, and dependence in walking.
Setting and Participants
Nursing home residents in the Czech Republic, England, Finland, France, Germany, Italy,
The Netherlands and Israel.
Of 3832 eligible residents, vitamin D, calcium and bisphosphonates were used by 16.2%,
10.4%, and 4.5% respectively. All 3 classes of OM together were used by 1.5% of all
residents. Of residents with a recent fracture, 9.5% used a bisphosphonate (2.7% all
3 OMs). In patients with recent falls, 20.8% used vitamin D and 15.3% calcium. In
residents with severe cognitive impairment, 15.5% used vitamin D and 9.3% used calcium.
Of the bisphosphonate users, 33.7% also used both vitamin D and calcium, 25.8% used
only calcium in addition and 17.4% only vitamin D in addition. The use of any OM varied
widely across countries, from 66.8% in Finland to 3.0% in Israel.
Conclusions and Implications
We found substantial pharmacological under-treatment of prevention of osteoporosis
in residents with recent falls, fractures and dependence in walking. Only two-thirds
of bisphosphonate users also took a vitamin D–calcium combination, despite guideline
recommendations. On the other hand, possible over-treatment was found in residents
with high mortality risk in whom preventive pharmacotherapy might not have still been
appropriate. The prevalence of pharmacological prevention of osteoporosis differed
substantially between countries. Efforts are needed to improve pharmacotherapy in