Background: Prevalence and incidence studies demonstrate that 70-95% of nursing facility residents (NFR) have osteoporosis. Fractures occur at a rate of 109 per 1000 female NFR per year. Despite the high prevalence of osteoporosis in US nursing facilities (NF), less than 10% of NFR receive appropriate pharmacologic treatment. Polypharmacy and complex medical conditions challenge effective treatment of osteoporosis in this setting. The evidence-base for osteoporosis treatment or fracture reduction is variable. Evidence to support the use of calcitonin for fracture reduction is limited. Purpose: To characterize NFR who are the most likely to receive calcitonin at NF admission. Methods: Of 186,221 NF residents admitted in KS, ME, MS, OH, and SD (1998-2000), 16,873 received appropriately dosed osteoporosis medications reported on Section U of the Minimum Data Set. Logistic regression revealed factors related to use of calcitonin (intranasal 200 IU) versus use of other appropriately dosed osteoporosis medications (i.e. calcium with vitamin D, bisphosphonates, estrogen, raloxifene). Results: Nine percent received appropriately dosed osteoporosis medications. Of NFR using osteoporosis medications, 18% use calcitonin. The odds of receiving calcitonin were higher among NFR with an osteoporosis diagnosis (Adjusted odds Ratio (OR):1.48; 95% Confidence interval (CI): 1.36-1.62), history of vertebral fracture (OR: 1.62, 95% CI: 1.49-1.76), use of oral steroids (OR: 1.18, 95% CI: 1.05-1.33), and history of gastrointestinal disease (OR: 1.23, 95% CI: 1.07-1.41). Advanced age and increasing level of physical impairment were associated with increased likelihood of calcitonin use. Fall and hip fracture history did not influence calcitonin use. Conclusion: Calcitonin use is common in NF, although not considered a first-line agent for osteoporosis treatment and fracture reduction. In the context of issues related to polypharmacy, risk to benefit ratios in substituting a suboptimal medication for osteoporosis treatment must be considered.
Disclosure Information:
Faculty Member's Name: Rollin M. Wright, MD
I have no relationships to disclose.
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