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Seema Parikh, MBBS, FRACP; Helen Mogun, MSc; Jerry Avorn, MD; Daniel H. Solomon, MD, MPH

Arch Intern Med. 2008;168(10):1111-1115.

Background  Little is known about osteoporosis medication use among high-risk patients in nursing homes (NHs). We studied the patterns and predictors of osteoporosis medication use in elderly patients who sustained a fracture and were admitted to an NH.

Methods  We linked pharmaceutical claims data from 2 state-run drug assistance programs for elderly patients to Medicare data for the years 1995 through 2004. We defined the rates of osteoporosis medication use among patients admitted to an NH following a hip, wrist, or humeral fracture for the 12-month period after the fracture. Predictors of using an osteoporosis medication were assessed in a multivariate Cox proportional hazards model adjusting for age and sex.

Results  Of the 4430 eligible postfracture patients, only 11.5% were prescribed an osteoporosis medication. There was a progressive increase in use from 1.6% in 1995 to 18.7% in 2001 but no increases in 2001 through 2004. Patient characteristics associated with osteoporosis medication use included a history of osteoporosis medication use in the prior 12 months (hazard ratio, 19.5; 95% confidence interval, 16.0-23.7) and female sex (hazard ratio, 1.57; 95% confidence interval, 1.13-2.21). A history of falls or fracture was not a significant factor. Calcitonin was the most commonly used osteoporosis medication (56%).

Conclusions  While the rate of osteoporosis medication use increased across the 10-year period, a low rate of osteoporosis medication use persists in the NH setting. More appropriate use of drug treatment of high-risk patients is needed in NHs.

Author Affiliations: Divisions of Pharmacoepidemiology and Pharmacoeconomics, (Drs Parikh, Avorn, and Solomon and Ms Mogun) and Rheumatology (Dr Solomon), Brigham and Womens' Hospital, Harvard Medical School, and Division of Gerontology, Beth Israel Deaconess Medical Center, Hebrew Senior Life (Dr Parikh), Boston, Massachusetts.

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