Underdiagnosis and undertreatment of nursing home residents at high risk for fragility fractures

Background: Identifying older individual at risk for fragility fractures is a priority among healthcare providers. However, the prevalence of osteoporosis, fragility fractures and the prescription of antifracture drugs among Nursing Home (NH) residents is almost ignored. The aim of this study is to describe the prevalence of osteoporosis and fragility fractures, and the main correlates of antifracture drug prescriptions among NH residents. Design: Observational multicentre prospective study. Setting: Nursing homes and assisted living facilities. Participants: 1995 NH residents aged 60 and older participating to the U.LI.S.S.E. (Un Link Informatico sui Servizi Sanitari Esistenti per l’Anziano) project were evaluated using a standardized comprehensive geriatric assessment instrument (Resident Assessment Instrument Minimum Data Set – RAI-MDS). Results: 256 (13%) persons (age 84.5±7.62 years) have diagnosis of osteoporosis without any fracture; 355 (17%) had previous fragility hip fracture with one out of three reporting a diagnosis of osteoporosis. An antifracture treatment is prescribed to 5.5% (n:111) of eligible persons: 18% of osteoporotic and 11% of hip fracture residents, respectively. Independent of age, gender, BMI and disability, subjects affected by osteoporosis are more likely to receive antifracture drugs (β=0.17, SE: 0.04; p: <0.0001),but not those with previous hip fracture. The probability to receive treatments decreases when dementia co-occurs (β=-0.07, SE: 0.03; p:0.05). Residents managed according with RAI-MDS show higher probability to receive appropriate antifracture treatment (β= 0.07, SE: 0.03; p: 0.01). Conclusion: NH residents at high risk for fragility fractures receive suboptimal care. Residents with a history of hip fracture or dementia are less likely to be treated, while those managed according to the geriatric comprehensive approach are more likely to receive adequate care.