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Posted: June 17, 2008

Nursing Homes Bypass Drug Therapy for Elderly at Risk of Osteoporosis

Nursing homes generally disregard guidelines encouraging use of drug therapy to strengthen bones in residents at risk of osteoporosis and other bone-brittling conditions, with only a small minority of at-risk elderly receiving such care, according to a new study. 

A medical research team from Brigham and Women's Hospital and Harvard Medical School found that of more than 4,400 older adults admitted to a nursing home after suffering a bone fracture, only 11.5% were prescribed a medication for osteoporosis.


The experts said this low incidence of preventive treatment exists despite guidelines recommending "strong consideration" of drug therapy that goes beyond the more basic vitamin D and calcium treatment for nursing home residents who are at risk of fractures.


"There is considerable room for improvement in the use of osteoporosis (drug therapy) in this high-risk nursing home population," Dr. Seema Parikh and colleagues wrote in the journal Archives of Internal Medicine.


Parikh’s team examined more than 4,400 elderly who were admitted to New Jersey nursing homes after suffering at least one fracture between 1995 and 2004. They found that just 11.5% were given an osteoporosis medication, although they also found that such prescriptions became more common over time. For example, in 1995, less than 2 of patients received an osteoporosis medication, compared with 19% in 2001 – but the rate stopped increasing after 2001.


The team wrote that the facilities may have opted to avoid osteoporosis therapy because they were concerned about side effects from osteoporosis drugs. As an example, Parikh’s group cited the drug raloxifene (branded Evista), which carries a risk of blood clots. They also said other medications called bisphosphonates (such as Fosamax and Actonel) can cause gastrointestinal irritation.


At the same time, researchers cited general guidelines that urge doctors to consider drug therapy for nursing home residents at risk of bone breaks, especially those who have already suffered a fracture, like those included in the study.


Based on the current findings, the researchers write, "Interventions aimed at enhancing osteoporosis treatment in nursing homes are vital."

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