Osteoporosis in the Nursing Home: Screening and Interventions for Fracture Prevention
Ward, Linda D.
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More than 80% of nursing home residents are believed to have osteoporosis, which leaves them susceptible to debilitating and life-threatening fractures. Vertebral fractures occur most commonly, causing pain, deformity and functional impairment. Fractures at other sites are associated with falls. Nursing home residents have a 60% risk to fall each year, with a hip fracture rate of 5-6%, nearly ten times that of community-dwelling persons the same age. Hip fracture in a nursing home resident is associated with a 41% mortality rate within four months, more than twice the rate for older persons who fracture a hip at home. Nursing home admission provides a critical opportunity to screen for osteoporosis and offer interventions to reduce the likelihood of fracture. A number of safe and effective therapies are available to improve bone health in nursing home residents, but no formal guidelines exist for preventing fractures in this most vulnerable population. A research-based analysis, that includes clinical, economic, and humanistic implications of available non-pharmacological and pharmacological interventions for osteoporosis, is presented. The analysis is synthesized as an algorithm for screening, preventing, and treating osteoporosis in nursing home residents.