Treatment patterns for osteoporosis in elderly women residing in the community and in long-term care facilities enrolled in Medicare

Abstract

Objectives This study compared treatment patterns and identified predictors for treatment use for osteoporosis in long-term care facility (LTCF) and community-residing elderly women. Methods A cross-sectional study using female Medicare beneficiaries aged 65 years and older with evidence of osteoporosis participating in the Medicare Current Beneficiary Survey between 1998 and 2003 was conducted. Outcome variable was use of prescription drugs used to treat osteoporosis, including bisphosphonates, calcitonin, estrogen, teriparatide and selective estrogen-receptor modulator. The main independent variable was residential status identified from survey data. Key findings The study sample included 4912 community dwellers and 453 LTCF residents with evidence of osteoporosis. The overall prevalence of treatment was 50.3% for community dwellers and 42.9% for LTCF residents. However, LTCF residents were more likely to be treated compared with community dwellers when controlling for other factors. Advancing age, African-American race, higher body mass index, breast cancer, impaired vision, Alzheimer's disease and more limits in activities of daily living were negatively associated with osteoporosis treatment. Having both a diagnosis and self-report of osteoporosis, all geographic regions outside Northeast, higher education and income level, supplemental medical insurance plus prescription drug coverage, history of hysterectomy, and use of chronic glucocorticoids and thyroid hormone were positively associated with osteoporosis treatment. Prevalence of osteoporosis treatment in LTCF residents improved markedly over the study period driven largely by increased use of bisphosphonates. Conclusion Elderly women residing in LTCFs are more likely to receive osteoporosis treatment compared with their community-based counterparts when other factors are taken into consideration.