Elderly/Long-term Care

Home health care following hospitalization for hip fracture may provide an opportunity to limit osteoporosis progression

Less than half of patients who have been hospitalized for hip fracture related to osteoporosis (loss of bone mass) are sent home with anti-osteoporosis medication to prevent further fractures. Since up to half of U.S. Medicare patients receive home health services after hospitalization for hip fracture, the home health care period may provide a window of opportunity for osteoporosis intervention.

Researchers analyzed databases of a large home health care agency to identify patients at high risk for fracture who received home health services during 2003 and 2004. Patients were considered at high fracture risk if they had a history of fracture, diagnosis of osteoporosis, current use of systemic glucocorticoids that induce bone loss, or a history of stroke that can increase the risk of falls.

Most patients were insured by Medicare. Only one-third of the high-risk group received any prescription (alendronate, risedronate, raloxifene, calcitonin, and terparatide) or over-the-counter calcium and vitamin D supplements to prevent or treat osteoporosis. Nearly three-fourths of the patients diagnosed with osteoporosis received either prescription medications or over-the-counter supplements.

In contrast, fewer than half of the patients specifically referred to home health care after suffering a fracture received any therapy. This finding is consistent with national data showing widespread undertreatment of osteoporosis. Patients with a history of stroke had the lowest rates of treatment in this high-risk group. A total of 26 percent of patients with no comorbidities received prescription osteoporosis medicine, which declined to 17 percent of patients with three or more coexisting conditions.

The study was supported in part by the Agency for Healthcare Research and Quality (HS10389).

See "Osteoporosis in the home health care setting: A window of opportunity?" by Jeffrey R. Curtis, M.D., M.P.H., Young Kim, M.S., Tara Bryant, M.D., and others, in the December 15, 2006, Arthritis & Rheumatism 55(6), pp. 971-975.

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