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. 2023 Jun 27;7(2):BJGPO.2022.0142.
doi: 10.3399/BJGPO.2022.0142. Print 2023 Jun.

Osteoporosis-related characteristics in care home residents in England: a retrospective cohort study

Vaiva Gerasimaviciute  1 , Rohini Mathur  2 , Kathryn Elizabeth Mansfield  3 , Matthew Paul McDermott  4 , David Edward Neasham  4 , James Liam O'Kelly  4
Affiliations

Osteoporosis-related characteristics in care home residents in England: a retrospective cohort study

Vaiva Gerasimaviciute et al. BJGP Open. .

Abstract

Background: The characteristics of care home populations, with respect to fracture risk factors, have not been well-defined.

Aim: To describe osteoporosis-related characteristics among care home residents, including fracture risk factors, fracture rates, post-fracture outcomes, and osteoporosis treatment duration.

Design & setting: A descriptive cohort study of care home residents aged ≥60 years (n = 8366) and a matched cohort of non-care home residents (n = 16 143) in England from 2012 to 2019. Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES) and Office for National Statistics (ONS) death data were used.

Method: The characteristics were assessed using descriptive statistics. Fracture risk factors and fracture rates were described in both the care home and matched population. In the care home population, Kaplan-Meier curves were plotted to assess osteoporosis treatment duration.

Results: At index, fracture risk factors were more common in care home residents versus the matched cohort, including body mass index (BMI) <18.5 (12.2% versus 5.1%), history of falls (48.9% versus 30.7%), prior fracture (26.5% versus 10.8%), and prior hip fracture (17.1% versus 5.8%). Fracture rate was 43.5 (95% confidence interval [CI] = 39.7 to 47.5) in care home residents and 28.0 (95% CI = 26.3 to 29.9) per 1000 person-years in the matched cohort. Overall, osteoporosis treatment was initiated in 3.6% (n = 225/6265) of care home residents and 45.9% remained on treatment at 12 months. Among care home residents who experienced fracture, 21.9% (n = 72/329) received an osteoporosis diagnosis; 21.2% (n = 63/297) initiated osteoporosis treatment post-hip fracture.

Conclusion: Care home residents had more fracture risk factors and higher fracture rates than the matched cohort; however, osteoporosis diagnosis, treatment rates, and treatment duration were low. There is an opportunity to improve osteoporosis management in this vulnerable population.

Keywords: general practice; homes for the aged; osteoporotic fractures.

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Conflict of interest statement

Vaiva Gerasimaviciute, David Edward Neasham, and James Liam O'Kelly are employees of and own stock in Amgen. Rohini Mathur and Kathryn Elizabeth Mansfield have received consultancy fees from Amgen.

Figures

Figure 1.
Figure 1.. Study population flow diagram. Cohort matched on age, sex, and practice. CPRD = Clinical Practice Research Datalink. HES = Hospital Episode Statistics. ONS = Office for National Statistics.
Figure 2.
Figure 2.. Crude fracture rates (error bars represent 95% confidence intervals) per 1000 person–years among care home residents and matched non-care home cohort in England from 2012 to 2019
Figure 3.
Figure 3.. Osteoporosis diagnosis and treatment after fracture among care home residents in England from 2012 to 2019. aRegardless of osteoporosis diagnosis.
Figure 4.
Figure 4.. Kaplan–Meier curve of treatment duration among new users of osteoporosis treatment in care homes in England from 2012 to 2019
See this image and copyright information in PMC

References

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