Wright Rollin M
Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
J Am Med Dir Assoc. 2007 Sep;8(7):453-7. doi: 10.1016/j.jamda.2007.04.002. Epub 2007 Aug 13.
Epidemiologic studies demonstrated that 70% to 85% of nursing home residents have osteoporosis. Few studies report comprehensive information about treatment of osteoporosis in nursing facilities.
To determine the prevalence of osteoporosis treatment and identify resident characteristics associated with the use of antiresorptive medications or supplements indicated to treat osteoporosis in nursing homes.
The study design was cross-sectional. The Systematic Assessment of Geriatric Drug Use via Epidemiology database provided the data. From this database, 186,221 residents were identified as newly admitted to nursing facilities in Kansas, Maine, Missouri, Ohio, and South Dakota between 1998 and 2000. The outcome measure was the use of antiresorptive medications (alendronate, risedronate, calcitonin, estrogen, raloxifene) or supplements (calcium with vitamin D) indicated for treatment of osteoporosis. The independent variables included demographic, health status, and fracture risk factors.
Of the overall sample, 9.1% received antiresorptive medications and/or supplements indicated for osteoporosis treatment. The most commonly used treatment was the combination of calcium and vitamin D (5.0%). Calcitonin (2.5%) use exceeded that of any other antiresorptive. Multivariable logistic regression analyses revealed that a diagnosis of osteoporosis and female gender were strongly associated with being more likely to receive an osteoporosis treatment (OR 6.34 with 95% CI 6.11-6.64 and OR 2.67 with 95% CI 2.53-2.83 respectively). The number of medications residents received was also strongly associated with receiving osteoporosis treatment. Being black and having 4 or more active diagnoses were strongly associated with lower odds of receiving treatment (OR 0.63 with 95% CI 0.57-0.68 and OR 0.71 with 95% CI 0.68-0.74 for 4 to 6 diagnoses).
Newly admitted nursing facility residents infrequently received an indicated osteoporosis treatment, including calcium with vitamin D, despite the expected high prevalence of osteoporosis in this setting. Few demographic, health status, and fracture risk factors were strongly associated with receiving indicated treatment.
流行病学研究表明，70%至85%的养老院居民患有骨质疏松症。很少有研究报告有关养老院中骨质疏松症治疗的全面信息。
确定骨质疏松症治疗的患病率，并确定与使用抗吸收药物或补充剂相关的居民特征，这些药物或补充剂用于治疗养老院中的骨质疏松症。
研究设计为横断面研究。通过流行病学数据库对老年药物使用进行系统评估提供数据。从该数据库中，确定了1998年至2000年间在堪萨斯州、缅因州、密苏里州、俄亥俄州和南达科他州新入住养老院的186,221名居民。结果指标是使用用于治疗骨质疏松症的抗吸收药物（阿仑膦酸盐、利塞膦酸盐、降钙素、雌激素、雷洛昔芬）或补充剂（钙加维生素D）。自变量包括人口统计学、健康状况和骨折风险因素。
在整个样本中，9.1%的人接受了用于骨质疏松症治疗的抗吸收药物和/或补充剂。最常用的治疗方法是钙和维生素D的组合（5.0%）。降钙素（2.5%）的使用超过了任何其他抗吸收药物。多变量逻辑回归分析显示，骨质疏松症诊断和女性性别与更有可能接受骨质疏松症治疗密切相关（分别为OR 6.34，95%CI 6.11 - 6.64和OR 2.67，95%CI 2.53 - 2.83）。居民接受的药物数量也与接受骨质疏松症治疗密切相关。黑人以及有4种或更多活跃诊断与接受治疗的几率较低密切相关（4至6种诊断时分别为OR 0.63，95%CI 0.57 - 0.68和OR 0.71，95%CI 0.68 - 0.74）。
尽管在此环境中骨质疏松症患病率预计很高，但新入住养老院的居民很少接受指定的骨质疏松症治疗，包括钙加维生素D。很少有人口统计学、健康状况和骨折风险因素与接受指定治疗密切相关。
