Risk factors that are associated with osteoporosis treatment in high risk residents living in long term care (LTC) homes? The gaining optimal osteoporosis assessments in long-term care (GOAL) study

Background: The GOAL initiative was developed to assess high risk residents and recommend appropriate pharmacotherapy to reduce fractures by utilizing multifaceted knowledge translation strategies. Method(s): GOAL is a delayed-entry stepped-wedge cluster randomized controlled trial in 50 long term care homes in Ontario. Information sources for the study included de-identified clinical/prescribing data from the database of a large pharmacy provider that services all study homes, chart audits, and the Resident Assessment Instrument Minimum Data Set (RAI-MDS). These data were entered into a pharmacist's electronic decision support tool that generated individual management recommendations and calculated the number of high risk residents living in long term care. High risk was based on the osteoporosis guidelines and was defined as those individuals who had at least one spine/hip fracture, 2 or more non-hip/non-spine fractures, or were currently taking corticosteroids (>7.5mg/d prednisone equivalent). Residents with previous diagnoses of osteoporosis were also considered at high risk. We determined whether there were associations among risk factors and osteoporosis treatment at baseline using the generalized estimating equations technique with an exchangeable correlation structure. The analysis was adjusted for risk factors and age. Values are expressed as odds ratios and 95% confidence intervals (CI). Result(s): Of the 6862 residents from 50 long term care 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. Overall, osteoporosis medications were taken by 37% (1101/2949) of high risk residents. Adjusted odds ratios indicated that a diagnosis of osteoporosis (3.2; 95% CI: 2.5, 4.0), prior spine fracture (1.9; 95% CI: 1.5, 2.5), and those currently taking corticosteroids (1.9; 95% CI: 1.2, 3.0) were factors associated with the use of osteoporosis treatment. Conclusion(s): A total of 43% of residents, living in long term care homes, are at high risk for fracture. Of these individuals, a diagnosis of osteoporosis, a prior spine fracture and those currently taking corticosteroids were characteristics that were found to be related with the use of osteoporosis treatment. Prior hip fractures did not appear to trigger the use of osteoporosis therapy.

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