Correlations of nursing home characteristics with prescription of osteoporosis medications

BackgroundOsteoporosis is highly prevalent in the nursing home (NH) populations but medications that increase bone mineral density are used infrequently. Prior research finds few patient characteristics predict treatment. NH characteristics have been associated with prescription of some medications. We examined associations of NH-level characteristics with osteoporosis treatment in elderly patients admitted to a NH after a fracture.MethodWe conducted a cohort study of patients with hip, wrist and humeral fractures admitted to a NH in NJ. They were followed for 12 months from 1999 to 2004. Possible NH-level predictors of receiving osteoporosis treatment were assessed in mixed multivariable models to account for clustering within individual NHs.ResultsOf the 2838 post-fracture patients identified from 180 NHs, 156 (5.5%) were prescribed an osteoporosis medication. There was wide variation in treatment between individual NHs (0–40%), which was substantially reduced after adjusting for patient case mix. Several patient characteristics did associate with osteoporosis treatment—female gender (odds ratio (OR) 2.56, 95% confidence interval (CI) 1.42, 4.61), younger age per year (OR 0.98, 95%CI 0.96, 0.99), white race (OR 2.37, 95%CI 1.23, 4.56) and prior history of fracture (OR 4.41, 95%CI 1.04, 18.73). However no NH characteristics significantly associate with treatment (profit status, NH chain member, occupancy rate, and bed size).ConclusionNH characteristics did not predict pharmacological treatment of osteoporosis. Further studies of osteoporosis prescribing in NHs need to consider other types of variables as possible correlates of prescribing.

Research Highlights
► We study the correlation of nursing home (NH) characteristics and prescription of osteoporosis medication in patients admitted after a recent fracture.
► Few high risk nursing home patients receive osteoporosis treatment.
► Rates of treatment vary among NHs.
► However once adjusted for patient case mix the differences minimize.
► Younger, female patients are more likely to receive medication with little influence of facility characteristics.