1 Osteoporosis management among residents living in long-term care L.M. Giangregorio M. Jantzi A.Papaioannou J. Hirdes C.J. Maxwell J.W. Poss Osteoporos Int 2009, 20:

Background Fractures in long-term care (LTC) residents have substantial economic and human costs. 2 Giangregorio LM et al: Osteoporos Int 2009, 20:

3 Describe the prevalence and predictors of osteoporosis management among long-term care facilities. Identify sociodemographic, clinical and functional characteristics associated with osteoporosis management. What are the objectives? Giangregorio LM et al: Osteoporos Int 2009, 20:

4 What methods were used? Retrospective study of 17 LTC facilities  13 in Ontario, 4 in Manitoba Used Resident Assessment Instrument  RAI 2.0 data Residents were 65+ years Inclusion criteria for osteoporosis group:  History of hip fracture  Any fracture within past 180 days  Diagnosis of osteoporosis  Prescribed osteoporosis medication Giangregorio LM et al: Osteoporos Int 2009, 20:

5 Description of Osteoporosis Group Characteristics (n = 525)mean or n (%) Age in years: mean (SD)86.2 (7.0) Number of Females: n (%)460 (87.6) Osteoporosis Diagnosis: n (%)292 (55.7) Diagnosis of Hip Fracture: n (%)181 (34.5) Diagnosis of Other Fracture: n (%)23 (4.4) Fracture(s) within the last 180 days: n (%)24 (4.6) Fall(s) within the last 180 days: n (%)177 (33.7) Faller(s) who experienced a fracture: %16% Taking any osteoporosis medication: %40% Giangregorio LM et al: Osteoporos Int 2009, 20:

6 What percentage of residents (n=525) received osteoporosis treatment? Giangregorio LM et al: Osteoporos Int 2009, 20:

MORE likely to receive treatment if:  Taking 10 or more medications 7 What are predictors of osteoporosis management in LTC? LESS likely to receive treatment if:  Have 6+ co-morbid conditions  Use a wheelchair  Have cognitive impairment  Have swallowing difficulties  Depression  From facility in Manitoba Giangregorio LM et al: Osteoporos Int 2009, 20:

8 Important considerations: 10% of residents were taking a bisphosphonate but were not taking vitamin D or a multivitamin Possible reasons for suboptimal osteoporosis management:  nonadherence  tolerability  length of treatment versus life expectancy or prognosis  prevention of polypharmacy or less focus on preventative health than on “presenting” conditions (Duque et al. J Am Med Dir Assoc 2007, 8, e67-e73) What are the issues in LTC osteoporosis management? Giangregorio LM et al: Osteoporos Int 2009, 20:

9 Osteoporosis Management: Is not optimal among residents at risk for future fracture Needs to identify at-risk subgroups of residents that are not receiving therapy in order to close the osteoporosis care gap What did we conclude? Giangregorio LM et al: Osteoporos Int 2009, 20:

Acknowledgments This study was an environmental scan conducted in association with the Ontario Osteoporosis Strategy and received funding from the Ontario Ministry of Health and Long-Term Care and McMaster University 10 Giangregorio LM et al: Osteoporos Int 2009, 20: