• C Colón-Emeric, K W Lyles, D A Levine, P House, A Schenck, J Gorospe, M Fermazin, K Oliver, J Alison, N Weisman, A Xie, J R Curtis, and K Saag.
• Duke University Center for Aging and Human Development, and the Durham VA GRECC, Erwin Rd, Durham, NC 27710, USA. colon001@mc.duke.edu
• Osteoporos Int. 2007 Apr 1; 18 (4): 553-9.

SummaryWe studied nursing home residents with osteoporosis or recent fracture to determine the frequency and predictors of osteoporosis treatment. There was wide variation in performance, and both clinical and systems variables predicted use. This study shows that improvement in osteoporosis care is possible and important for many nursing homes.IntroductionWe determined the prevalence and predictors of osteoporosis evaluation and treatment in high-risk nursing home residents.MethodsWe identified 67 nursing facilities in North Carolina and Arizona with > 10 residents with osteoporosis or recent hip fracture. Medical records (n=895) were abstracted for osteoporosis evaluation [dual-energy X-ray absorptiometry (DXA), vitamin D level, serum calcium), treatment (calcium, vitamin D, osteoporosis medication, hip protectors), clinical, and systems covariates. Data were analyzed at the facility level using mixed models to account for the complex nesting of residents within providers and nursing facilities.ResultsCalcium and vitamin D was prescribed for 69% of residents, bisphosphonates for 19%, calcitonin for 14%, other pharmacologic therapies for 6%, and hip protectors for 2%. Overall, 36% received any bone protection (medication or hip protectors), with wide variation among facilities (0-85%). Factors significantly associated with any bone protection included female gender [odds ratio (OR) 2.4, (1.5-3.7)] and nonurban/suburban location [1.5, (1.1-2.2)]. Residents with esophagitis, peptic ulcer disease (PUD), or dysphagia [0.6, (0.4-0.9)] and alcohol abuse [0.2, (0.0-0.9)] were less likely to receive treatment.ConclusionsThere is substantial variation in the quality of osteoporosis treatment across nursing homes. Interventions that improve osteoporosis quality of care are needed.

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