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Fu SH, Lai CY, Wang CY, Hung CC, Ye JD, Yen HK, Wu CH, Ku LJE, Yu T, Yang RS, Hsiao FY, Li CY. Screening of Fracture Risk and Osteoporosis Among Older Long-term Care Residents: A Prospective Study. J Nutr Health Aging 2023; 27:1255-1261. [PMID: 38151877 DOI: 10.1007/s12603-023-2045-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/02/2023] [Indexed: 12/29/2023]
Abstract
This prospective study assessed the effectiveness of screening older long-term care residents (LTCRs) for fracture risk and osteoporosis in Taiwan. Fracture risk screening was done using the Fracture Risk Assessment Tool (FRAX), and those with high or moderate risk were offered osteoporosis workup and treatment at the hospital. Among 785 LTCRs screened, 338 men (mean age 75.6) and 447 women (mean age 81.2) were included. Only 5.2% of women and no men were using anti-osteoporosis medication. Based on the Bone Health and Osteoporosis Foundation (BHOF) recommendations, 69.2% of men and 92.6% of women were classified as high fracture risk. In 110 participants willing to receive bone mineral density examination, osteoporosis was diagnosed in 86.2% of women and half of men. FRAX could effectively differentiate fracture risk in 648 LTCRs who completed 2-year follow-ups; no fracture occurred in the low-risk group. The study emphasizes the importance of fracture risk screening to enhance osteoporosis diagnosis and treatment among LTCRs.
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Affiliation(s)
- S-H Fu
- Chung-Yi Li, Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, No. 138, Sheng Li Road, Tainan City 704, Taiwan, , Tel: +886-6-2353535, ext. 5862 and 5863
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Berry SD, Daiello LA, Lee Y, Zullo AR, Wright NC, Curtis JR, Kiel DP. Secular Trends in the Incidence of Hip Fracture Among Nursing Home Residents. J Bone Miner Res 2020; 35:1668-1675. [PMID: 32302028 PMCID: PMC7486242 DOI: 10.1002/jbmr.4032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/28/2020] [Accepted: 04/13/2020] [Indexed: 12/30/2022]
Abstract
A recent study suggested a decline in the incidence of hip fracture among US women between 2002 and 2012, followed by a leveling in the incidence rate from 2013 to 2015. Newly admitted nursing home residents are particularly vulnerable to hip fracture, and it is unclear whether that trend is observed in this high risk group. The purpose of our study was to describe trends in hip fracture rates and postfracture mortality among 2.6 million newly admitted US nursing home residents from 2007 to 2015, and to examine whether these trends could be explained by differences in resident characteristics. Medicare claims data were linked with the Minimum Data Set (MDS), a clinical assessment performed quarterly on all nursing home residents. In each year (2007-2015), we identified newly admitted long-stay (ie, 100 days in the same facility) nursing home residents. Hip fracture was defined using Medicare Part A diagnostic codes. Follow-up time was calculated from the index date until the first event of hospitalized hip fracture, Medicare disenrollment, death, or until 1 year. Poisson regression was used to adjust rates of hip fracture for age and sex. The number of newly admitted nursing home residents ranged from 324,508 in 2007 to 257,350 in 2015. Although mean age remained similar (83 years), residents were more functionally dependent over time. There was a small absolute decrease in the incidence rate of hip fracture between 2007 (3.32/100 person-years) and 2013 (2.82/100 person-years), with an increase again in 2015 (3.03/100 person-years). Adjusting for patient characteristics somewhat attenuated these trends. One-year mortality was high following fracture in all years (42.6% in 2007, 42.1% in 2014). In summary, we observed a recent slight rise in the incidence rates of hip fracture among nursing home residents that was at least partially explained by differences in resident characteristics over time. © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
- Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
| | - Lori A Daiello
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey R Curtis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Douglas P Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
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Berry SD, Zullo AR, Lee Y, Mor V, McConeghy KW, Banerjee G, D'Agostino RB, Daiello L, Dosa D, Kiel DP. Fracture Risk Assessment in Long-term Care (FRAiL): Development and Validation of a Prediction Model. J Gerontol A Biol Sci Med Sci 2019; 73:763-769. [PMID: 28958013 DOI: 10.1093/gerona/glx147] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 08/02/2017] [Indexed: 11/13/2022] Open
Abstract
Background Strategies used to predict fracture in community-dwellers may not be useful in the nursing home (NH). Our objective was to develop and validate a model (Fracture Risk Assessment in Long-term Care [FRAiL]) to predict the 2-year risk of hip fracture in NH residents using readily available clinical characteristics. Methods The derivation cohort consisted of 419,668 residents between May 1, 2007 and April 30, 2008 in fee-for service Medicare. Hip fractures were identified using Part A diagnostic codes. Resident characteristics were obtained using the Minimum Data Set and Part D claims. Multivariable competing risk regression was used to model 2-year risk of hip fracture. We validated the model in a remaining 1/3 sample (n = 209,834) and in a separate cohort in 2011 (n = 858,636). Results Mean age was 84 years (range 65-113 years) and 74.5% were female. During 1.8 years mean follow-up, 14,553 residents (3.5%) experienced a hip fracture. Fifteen characteristics in the final model were associated with an increased risk of hip fracture including dementia severity, ability to transfer and walk independently, prior falls, wandering, and diabetes. In the derivation sample, the concordance index was 0.69 in men and 0.71 in women. Calibration was excellent. Results were similar in the internal and external validation samples. Conclusions The FRAiL model was developed specifically to identify NH residents at greatest risk for hip fracture, and it identifies a different pattern of risk factors compared with community models. This practical model could be used to screen NH residents for fracture risk and to target intervention strategies.
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Affiliation(s)
- Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Hebrew SeniorLife, Institute for Aging Research, Boston, Massachusetts
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Vincent Mor
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Kevin W McConeghy
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Geetanjoli Banerjee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Ralph B D'Agostino
- Department of Mathematics and Statistics, Boston University, Massachusetts
| | - Lori Daiello
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - David Dosa
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Douglas P Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Hebrew SeniorLife, Institute for Aging Research, Boston, Massachusetts
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Abstract
OBJECTIVE To evaluate the prescription of bisphosphonates in female nursing home residents aged 75 and older with a history of proximal femoral fracture. DESIGN Observational descriptive study, led in Brest, France, between June and August 2015. SETTING 12 nursing homes in Brest, France. PARTICIPANTS Female nursing home residents, aged 75 and older, with a history of proximal femoral fracture were included. Exclusion criteria were contraindications to bisphosphonate treatment and residents restricted to bed and chair. MEASUREMENTS The primary endpoint was the evaluation of prescription of bisphosphonates at the time of the study. The secondary endpoints were to evaluate vitamin D supplementation and factors associated with bisphosphonate prescription. RESULTS 12 of the 116 included residents (10.3 %) received bisphosphonates. 66.4 % received vitamin D supplementation. CONCLUSION Despite successive French and international recommendations, there is still a very important underuse of treatment by bisphosphonates in old institutionalized female patients with a very high risk of fracture.
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Affiliation(s)
- P Le Floch
- Paul Le Floch, CHRU de Brest, Brest, France,
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Abstract
OBJECTIVE To evaluate the cost-effectiveness of routine administration of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA. DESIGN Markov cohort simulation model based on published literature from a healthcare sector perspective over a lifetime horizon. SETTING Nursing homes. PARTICIPANTS A hypothetical cohort of nursing home residents aged 85 years with osteoporosis. INTERVENTIONS Two strategies were compared: (1) a single intravenous dose of zoledronic acid 5 mg and (2) usual care (supplementation of calcium and vitamin D only). PRIMARY AND SECONDARY OUTCOME MEASURES Incremental cost-effectiveness ratio (ICER), as measured by cost per quality-adjusted life year (QALY) gained. RESULTS Compared with usual care, zoledronic acid had an ICER of $207 400 per QALY gained and was not cost-effective at a conventional willingness-to-pay threshold of $100 000 per QALY gained. The results were robust to a reasonable range of assumptions about incidence, mortality, quality-of-life effects and the cost of hip fracture and the cost of zoledronic acid. Zoledronic acid had a potential to become cost-effective if a fracture risk reduction with zoledronic acid was higher than 23% or if 6-month mortality in nursing home residents was lower than 16%. Probabilistic sensitivity analysis showed that the zoledronic acid would be cost-effective in 14%, 27% and 44% of simulations at willingness-to-pay thresholds of $50 000, $100 000 or $200 000 per QALY gained, respectively. CONCLUSIONS Routine administration of single-dose zoledronic acid in nursing home residents with osteoporosis is not a cost-effective use of resources in the USA but could be justifiable in those with a favourable life expectancy.
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Affiliation(s)
- Kouta Ito
- Department of Medicine, Hebrew SeniorLife, Roslindale, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Greenspan SL, Perera S, Resnick NM. Dosing Strategies of Bone-Targeting Agents-Reply. JAMA Intern Med 2015; 175:1865-6. [PMID: 26524746 PMCID: PMC4869321 DOI: 10.1001/jamainternmed.2015.4799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Susan L Greenspan
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Subashan Perera
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Neil M Resnick
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Kennedy CC, Ioannidis G, Thabane L, Adachi JD, O’Donnell D, Giangregorio LM, Pickard LE, Papaioannou A. Osteoporosis prescribing in long-term care: impact of a provincial knowledge translation strategy. Can J Aging 2015; 34:137-48. [PMID: 25850439 PMCID: PMC5104546 DOI: 10.1017/s0714980815000057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This study described prescribing trends before and after implementing a provincial strategy aimed at improving osteoporosis and fracture prevention in Ontario long-term care (LTC) homes. Data were obtained from a pharmacy provider for 10 LTC homes in 2007 and 166 homes in 2012. We used weighted, multiple linear regression analyses to examine facility-level changes in vitamin D, calcium, and osteoporosis medication prescribing rates between 2007 and 2012. After five years, the estimated increase in vitamin D, calcium, and osteoporosis medication prescribing rates, respectively, was 38.2 per cent (95% confidence interval [CI]: 29.0, 47.3; p < .001), 4.0 per cent (95% CI: -3.9, 12.0; p = .318), and 0.2 per cent (95% CI: -3.3, 3.7; p = .91). Although the study could not assess causality, findings suggest that wide-scale knowledge translation activities successfully improved vitamin D prescribing rates, although ongoing efforts are needed to target homes with low uptake.
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Affiliation(s)
- Courtney C. Kennedy
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
| | - George Ioannidis
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
| | - Lehana Thabane
- Clinical Epidemiology and Biostatistics, McMaster University
- St Joseph’s Healthcare – Hamilton
| | - Jonathan D. Adachi
- Department of Medicine, McMaster University
- St Joseph’s Healthcare – Hamilton
- Alliance for Better Bone Health Chair in Rheumatology
| | | | | | - Laura E. Pickard
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
- Eli Lilly Canada Chair in Osteoporosis
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