The deprescribing of calcium supplements in a state operated developmental center: a 10-year longitudinal pilot study

Abstract

This study was conducted at the Ann M. Kiley Center, one of eight long-term care facilities in Illinois serving individuals with developmental disabilities. We investigated deprescribing calcium supplementation and replacing calcitriol with infrequent ergocalciferol to augment vitamin D in residents at risk for bone fractures at our facility. Primary objective was the overall occurrence of fractures before and after pharmacy intervention. Secondary objectives were estimating drug acquisition, dispensing, and administration costs. Facility-wide deprescribing of calcium supplements and calcitriol began in August 2008. Ergocalciferol at a dose of 50 000–200 000 IU monthly was initiated to augment and replace vitamin D therapy. The overall occurrence of bone fractures were measured 5 years prior to intervention (August 2003 to August 2008) and compared with occurrences over the 5 year intervention period (Sept. 2008 to Sept. 2013). One or more fractures occurred among 34 (15%) of the residents prior to intervention as compared to 27 (12·7%) after intervention. Prior to intervention, 55 bones were fractured, yielding a rate of 5 fractures per 100 persons/year. After intervention, 42 bones were fractured yielding a rate of 4 fractures per 100 persons/year. This demonstrated a 20% reduction in rate of fractures at our facility. Additionally, we observed a reduction in drug acquisition, dispensing, and administration costs and savings of roughly $200 000 per year. Although the results are preliminary, we found that deprescribing calcium supplements, while using infrequent ergocalciferol to augment and replace vitamin D resulted both improved health outcomes and substantial cost savings at our facility.