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Pharmacological management of osteoporosis in nursing home residents: the Shelter study

  • Alireza Malek Makan
    Affiliations
    Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands

    Care Group Coloriet, Lelystad, the Netherlands

    Care group Almere, Almere, the Netherlands
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  • Hein van Hout
    Correspondence
    Corresponding author at: Amsterdam University Medical Centers, General Practice & Elderly Care Medicine, Amsterdam Public Health Institute, Van der Boechorststraat 7, 1081BT Amsterdam, the Netherlands.
    Affiliations
    Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands
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  • Graziano Onder
    Affiliations
    Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
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  • Henriëtte van der Roest
    Affiliations
    Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands
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  • Harriet Finne-Soveri
    Affiliations
    Department of Welfare, National Institute for Health and Welfare, Finland
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  • Eva Topinková
    Affiliations
    Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic

    Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
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  • Michael Denkinger
    Affiliations
    Agaplesion Bethesda Clinic, Geriatric Centre Ulm/Alb-Donau, Ulm University, Ulm, Germany
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  • Jacob Gindin
    Affiliations
    Department of Geriatrics, Assuta Medical Centers, Tel Aviv, Israel
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  • Rob van Marum
    Affiliations
    Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands

    Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
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      Highlights

      • We found substantial pharmacological under-treatment as well as over-treatment of osteoporosis in nursing home residents.
      • Substantial country differences were found.
      • Efforts are needed to improve pharmacotherapy in nursing home residents.

      Abstract

      Objective

      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.

      Design

      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.

      Results

      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 residents.

      Keywords

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