Major osteoporotic fractures are common, morbid, and costly among long-stay nursing home residents. Despite the importance of this problem, there are no guidelines to screen nursing home residents for osteoporosis, and it is unclear which osteoporosis medications prevent fractures in long-stay residents. To address these gaps of knowledge we propose the following specific aims: 1) develop and validate a prediction tool using clinical risk factors for falls and fracture that will estimate the 2 year absolute risk of hip fracture and the year absolute risk of major osteoporotic fracture (hip, humerus, and wrist combined) in long-stay nursing home residents; 2) determine whether osteoporosis medications (i.e., bisphosphonates, calcitonin, estrogen, raloxifene, and teriparatide) reduce the incidence of hip and major osteoporotic fracture in long-stay nursing home residents; and 3) determine the clinical thresholds of risk at which osteoporosis medications reduce the incidence of hip and major osteoporotic fracture by e 20% in long-stay residents. This project will leverage an existing database that has previously linked claims data from Medicare Parts A and B with pharmacy data (Medicare Part D), clinical characteristics (Minimum Data Set), and facility level characteristics (OSCAR). Using this database we will conduct a prospective analysis on all U.S. nursing home residents enrolled in a Medicare fee-for-service plan and with e 90 day length of stay between the years 2006-2011 (>700,000 residents annually).
For specific aim 1, the prediction tools will be developed entirely from clinical information that is available for all U.S long-stay residents, such as cognitive and functional status, non-osteoporosis medication use, and recent history of falls. The prediction tools will account for the high mortality in nursing home residents.
For specific aim 2 a, we will determine whether osteoporosis medications reduce the incidence of hip and major osteoporotic fracture in long-stay residents by comparing the incidence of fracture among new users of an osteoporosis medication with the incidence of fracture in non-users, matched by propensity scores.
For specific aim 2 b, we will determine a threshold for pharmacologic intervention by examining the efficacy of osteoporosis drugs according to baseline fracture risk, as estimated by the fracture prediction tool. The research team has experience in pharmacoepidemiology, geriatrics, and analysis of Medicare claims data and Minimum Data Set characteristics necessary to complete this project. Our findings will be highly significant as they will provide the first guidance on screening and treatment of osteoporosis in the nursing home setting. We anticipate that our findings will be easy for providers to implement because the fracture prediction tools will be comprised of clinical information that is already available for all U.S. nursing home residents. Knowledge gained from this study could ultimately result in a decreased rate of major osteoporotic fractures in the nursing home setting, with a subsequent reduction in morbidity and health care costs.

Public Health Relevance

Fractures are a major cause of morbidity and expense in the nursing home. The purpose of this project is to develop a screening tool for osteoporosis and to use the screening tool to determine a threshold at which osteoporosis medications prevent fractures. Implementation of this tool is likely to improve quality of care in nursing homes by reducing fractures and simultaneously reducing costs.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG045441-02
Application #
8930041
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Joseph, Lyndon
Project Start
2014-09-30
Project End
2018-04-30
Budget Start
2015-05-01
Budget End
2016-04-30
Support Year
2
Fiscal Year
2015
Total Cost
Indirect Cost
Name
Hebrew Rehabilitation Center for Aged
Department
Type
DUNS #
030832075
City
Boston
State
MA
Country
United States
Zip Code
Zullo, Andrew R; Zhang, Tingting; Beaudoin, Francesca L et al. (2018) Pain Treatments After Hip Fracture Among Older Nursing Home Residents. J Am Med Dir Assoc 19:174-176
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Berry, Sarah D; Zullo, Andrew R; Lee, Yoojin et al. (2018) Fracture Risk Assessment in Long-term Care (FRAiL): Development and Validation of a Prediction Model. J Gerontol A Biol Sci Med Sci 73:763-769
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Banerjee, Geetanjoli; Zullo, Andrew R; Berry, Sarah D et al. (2016) Geographic Variation in Hip Fracture Among United States Long-Stay Nursing Home Residents. J Am Med Dir Assoc 17:865.e1-3

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