Abstract
Osteoporotic fractures are a common and serious health problem for older adults living
in nursing homes (NHs). Risk of fracture increases with age and dementia status, yet
gaps in evidence result in controversies around when to start and stop treatment for
osteoporosis in NH residents, particularly those who have high fracture risk but have
limited life expectancy. In this article, we discuss these areas of controversy. We
provide an overview of current guidelines that explicitly address osteoporosis treatment
strategies for NH residents, review the evidence for osteoporosis medications in NH
residents, and use these sources to suggest practical recommendations for clinical
practice and for research. Three published guidelines (from the United States, Canada,
and Australia) and several studies provide the current basis for clinical decisions
about osteoporosis treatment for NH residents. Practical approaches may include broad
use of vitamin D and selective use of osteoporosis medication based on risks, benefits,
and goals of care. Clinicians still lack strong evidence to guide treatment of NH
residents with advanced dementia, multimorbidity, or severe mobility impairment. Future
priorities for research include identifying optimal approaches to risk stratification
and prevention strategies for NH residents and evaluating the risk-benefit profile
of pharmacologic treatments for osteoporosis NH residents across key clinical strata.
In the absence of such evidence, decisions for initiating and continuing treatment
should reflect a patient-centered approach that incorporates life expectancy, goals
of care, and the potential burden of treatment.
Keywords
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Article Info
Publication History
Published online: November 03, 2022
Accepted:
September 30,
2022
Received in revised form:
September 26,
2022
Received:
June 13,
2022
Publication stage
In Press Uncorrected ProofFootnotes
Joshua Niznik and Meredith Gilliam are co–primary authors.
J.N. is supported by a K08 award from the National Institute on Aging (NIA; K08 AG071794 ). S.B. receives funds to mentor through a grant from the NIA ( K24 AG070106 ).
The authors declare no conflicts of interest.
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
