What triggers osteoporosis therapy in high risk residents living in long term care (LTC) homes? The gaining optimal osteoporosis assessments in long-term care (GOAL) study

Objective: The GOAL initiative was developed to assess high risk residents and recommend appropriate pharmacotherapy to reduce fractures by utilizing multifaceted knowledge translation strategies. These strategies were directed at the inter-professional team in the LTC homes. Method(s): GOAL is a delayed entry stepped wedge cluster randomized controlled trial in 50 LTC homes in Ontario. De-identified clinical/prescribing data were downloaded from the database of a large pharmacy provider that services all study homes. Chart audits were performed and the Resident Assessment Instrument Minimum Data Set (RAI-MDS) data were examined to determine the number of high risk residents for fracture. In this baseline analysis, we calculated the proportion of high-risk residents who were receiving osteoporosis medications and vitamin D (>=800 mg/d), according to specific high risk categories. Based on osteoporosis guidelines, high-risk was identified as individuals who had at least one spine/ hip fracture, 2 or more non-hip/non-spine fractures, or were currently taking corticosteroids (>7.5 mg/d prednisone equivalent). Residents who had a previous diagnosis of osteoporosis were also considered at high risk. Result(s): Of the 6862 residents from 50 LTC homes who were evaluated, a total of 2949 (43.0 %) were considered at high risk. High risk residents had a mean age (SD) of 85.9 (9.0) years, weighed 64 (17.1) kg and were 158.5(10) cm tall. Osteoporosis medications were taken by 47 % (151/320), 34 % (294/874), 38 % (51/136), 43 % (58/134) and 41 % (976/2395) of residents who had a prior spine fracture, hip fracture, two or more non-hip or non-spine fractures, were taking corticosteroids, or had a diagnosis of osteoporosis, respectively. In addition, 77 % (2255/2949) of high risk residents were on vitamin D therapy. Conclusion(s): Residents with prior spine fractures had the highest and those with prior hip fractures had the lowest percentages of receiving osteoporosis medications. Our findings suggest a potential osteoporosis treatment gap that may be reduced though knowledge translation strategies.