Osteoporosis drugs little used in nursing homes

Few nursing home patients at high risk of bone fractures are given medications to strengthen their bones, a new study suggests.

Researchers found that of more than 4,400 older adults admitted to a nursing home after sustaining a fracture, only 11.5 percent were prescribed a medication for the bone-thinning disease osteoporosis.

This, the investigators say, is despite the fact that guidelines recommend “strong consideration” of drug therapy, beyond vitamin D and calcium, for nursing home patients 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 at Brigham and Women’s Hospital and Harvard Medical School write in the Archives of Internal Medicine.

The researchers based their findings on data from 4,430 elderly adults who sustained a bone fracture and were subsequently admitted to a New Jersey nursing home between 1995 and 2004.

Overall, just 11.5 percent were given an osteoporosis medication, though prescriptions became more common over time. In 1995, less than 2 percent of patients received an osteoporosis medication, compared with 19 percent in 2001. The rate did not continue to increase after 2001, however.

Worries about osteoporosis drug side effects might be one reason for the low prescription rate, Parikh’s team speculates. The drug raloxifene (Evista), for example, carries a risk of blood clots, while medications called bisphosphonates (such as Fosamax and Actonel) can cause gastrointestinal irritation.

However, the researchers point out, general guidelines call on doctors to consider drug therapy for nursing home patients at risk of bone breaks—particularly those who have already suffered a fracture.

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

SOURCE: Archives of Internal Medicine, May 26, 2008.