Objectives: To describe demographic and clinical risk factors for osteoporosis among persons aged 60 years and older residing in assisted living facilities and to compare the frequency of bone-mineral density (BMD) testing and initiation of pharmacotherapy for osteoporosis (prevention/treatment) in both a control and experimental cohort.
Design: Prospective cohort study.
Setting: Sixteen separate assisted living facilities from November 2001 through July 2002.
Participants: Assisted living facility ambulatory residents (N = 111) aged 60 years and older.
Intervention: Based on the subject's risk factors for osteoporosis and FRACTURE Index score (female subjects only), written recommendations were made from a multidisciplinary team to increase the percentage of residents evaluated (via central dual-energy x-ray absorptiometry [DEXA] scan) and/or treated for osteoporosis.
Main outcome measures: FRACTURE Index was calculated on all female participants and reported with BMD or without BMD results by convention. An investigator-developed osteoporosis risk-factor assessment questionnaire was used to evaluate risk factors present for each participant. Numbers of subjects being evaluated for osteoporosis via DEXA scan and numbers of subjects having pharmacotherapy altered to prevent or treat osteoporosis were recorded.
Results: One hundred eleven older adults (average age 84 [range 60-94], SD = 6.5 years) participated in the study. As a group the female cohort with no known previous diagnosis of osteoporosis were at high risk for fracture over the next five years as evidenced by an average FRACTURE Index score of 6.6 and 7.2 (control and intervention group, respectively) without BMD, and 9.9 and 10.3 (control and intervention group, respectively) with BMD, respectively. At study end, a significant number of participants in the intervention group had initiated the use of calcium or vitamin D supplements (P = 0.016 and P = 0.031, respectively). The initiation of bisphosphonates in eight subjects over the six-month study period was also significant (P = 0.008) in the intervention group. No significant changes in the use of calcium or vitamin D or specific osteoporosis therapies were realized in the control group. In the intervention group, physician contact did not result in a significant increase in the numbers of participants receiving a BMD evaluation.
Conclusion: As a whole, residents residing in assisted living facilities are at high risk of having osteoporosis and/or sustaining a fracture. When assessment of osteoporosis and fracture risk is communicated to a physician, use of therapies aimed to improve bone health increases. In this study, there was a significant increase in the use of calcium, vitamin D, and bisphosphonates in the intervention cohort. However, physician contact did not result in more participants receiving a BMD evaluation.