MedWire News: Around one-third of elderly patients in nursing homes harbor vertebral fractures and half have osteoporosis, report Swiss researchers who found that few residents receive suitable therapies.
Studies have revealed that nursing home residents are between three and 11 times more likely to sustain osteoporotic fractures than age- and gender-matched community dwellers. Of note, nearly 40% of hip fractures occur in nursing home residents.
The prevalence of vertebral fracture in nursing home residents is not known, however.
In the current study, Rene Rizzoli (Geneva University Hospitals and Faculty of Medicine) and colleagues assessed 151 residents of five nursing homes in the Geneva area, aged between 64 and 98 years (average age 85.9 years).
Inclusion criteria included an estimated life expectancy greater than 1 year; exclusion criteria included inability to climb the four stairs to get into the mobile assessment truck, cognitive impairment, and active cancer.
Participants filled out a questionnaire concerning osteoporotic risk factors, history of falls, and current medication. Bone mineral density (BMD) and bone mineral content were assessed with a mobile dual-emission X-ray absorptiometry (DXA) osteodensitometer, and vertebral body deformity was evaluated with the subject in supine position.
The Fracture Risk Assessment tool was used to determine 10-year fracture probability.
Rizzoli et al report that 36% of the participants had a vertebral fracture. The majority of fractures were detected at T12 and L1 levels, however, not all vertebral body could be visualized and analysed, particularly at T4 to T6.
The 10-year fracture probability was 27% and 15% for major fractures and for hip fracture, respectively. Adding BMD and/or DXA-based vertebral fracture analysis (VFA) results did not markedly modify this probability.
This could indicate that most of the fracture risk was captured by age and the medical history of prevalent fracture, which was as high as 44% (50% in women and 22% in men).
Despite this fracture history and the fact that 52% of residents had had osteoporosis, very few were receiving any therapy, with less than 21% using calcium and/or vitamin D, and even fewer receiving bone loss treatments.
"Implementation of effective fracture prevention efforts should be a priority at the time of admission to nursing homes since fracture incidence is the highest during the first months after admission," Rizzoli et al comment in Osteoporosis International.
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