Undertreatment of osteoporosis (OP) in nursing home residents

Background: OP is common in nursing home (NH) residents. The goals of pharmacologic therapy include reducing fractures and related morbidity. Antiosteoporotic (AOP) drug use in the NH setting has not been well studied. Objectives: To determine the proportion of NH residents ≥65 years with OP receiving AOP drug treatment and identify predictors of AOP drug use. Methods: We identified 29,357 residents with OP documented on the Minimum Data Set collected on residents of all NH facilities in 5 states (1992-96). A multiple logistic regression model was used, with the dependant variable being use of any AOP drugs. Results: Twenty-five percent of residents received AOP drugs. Women were more likely than men to receive AOP [Odds Ratio (OR) 1.41, 95% Confidence Interval (CI): 1.26-1.57]. Both increasing age and level of cognitive impairment were inversely related to receipt of AOP drugs. A history of fracture or falls was not predictive of AOP drug use. Treatment was less likely for residents with ≥6 medical conditions [OR 0.55, 95% CI 0.51, 0.59]; those admitted to NH from a hospital [OR 0.86, 95% CI 0.80-0.92]; and those with a terminal prognosis [OR 0.60, 95% CI 0.42-0.87]. Conclusions: The majority of residents with OP did not receive drug therapy for this disabling and treatable disease. Although acceptable reasons may exist in some of these residents, others, especially the oldest old, may not be receiving adequate care.