Correlations of nursing home characteristics with prescription of osteoporosis medications

Abstract

Background: Osteoporosis 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.

Method: We 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.

Results: Of 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).

Conclusion: NH 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.

Figure 1

Each point represents a NH and they are ordered according to the rate of treatment.

Figure 2

Each point represents the predicted probability of receiving osteoporosis medication by individual NH. The predicted probability was estimated for the average nursing home patient with the following characteristics: age 86, female, white, Charlson Score=3, no prior steroids, no previous peptic ulcer gastro-esophageal reflux disease or osteoporosis, has prior fracture, falls, and dementia, no prior BMD test, on Medicaid. Each NH may vary with respect to number of beds, ownership, neighborhood, occupancy, and for profit status.