Older adults living in long-term care are more than twice as likely as their peers living at home to suffer a fracture, and a new guideline endorsed by the Scientific Advisory Council of Osteoporosis Canada explains how to reduce their risk.
Residents of long-term care tend to be more frail and have more health problems than similar people who live on their own, which explains the higher risk of fractures in long-term care facilities, said lead author Dr. Alexandra Papaioannou of McMaster University and Hamilton Health Sciences in Hamilton, Ontario.
"Up to a third of seniors in long-term care suffer a fracture," often of the hip or spine, she said. For these residents, "long-term care is their home, the nurses know them, and acute care can be a frightening traumatic experience for residents."
The authors developed the new guideline based on input from older people and their families, who most wanted to avoid pain, loss of activity and hospitalization, Papaioannou told Reuters Health. They also studied published literature on the risks and benefits of strategies to prevent fracture.
The guideline strongly recommends calcium supplementation of 1,200 milligrams of calcium, or three servings of diary, daily for people older than age 70. These calcium levels reduce hip fracture risk and slightly reduce the risk of other fractures, but they may also cause gastrointestinal side effects. For residents who want to avoid these, supplementation may not be a good option, the authors write.
High-risk residents, like those with prior fractures, should also take daily vitamin D3 supplements, which are more affordable than vitamin D2, the authors write in the Canadian Medical Association Journal.
They also recommend that high-risk residents take the medications alendronate weekly, or risedronate weekly or monthly, as first-line therapy to prevent fractures, as long as they do not have difficulty swallowing.
High-risk residents who are mobile should wear hip-protectors, which can protect against fracture in the event of a fall. Low-risk residents who are mobile may wear the devices, depending on their values and preferences.
Balance, strength and functional exercise can help prevent falls for low-risk residents, and may be useful for high-risk residents, but the exercise itself increases the risk of fall slightly, so their caregivers should keep that in mind.
Lastly, the authors recommend that all residents have "multifactorial interventions" that are tailored to each individual and include medication reviews, environmental hazard assessment, assistive device use, exercise and educational interventions for staff.
"Many residents have multiple medical conditions and we need to make sure that they include their lifespan and goals of care in the assessment," Papaioannou said. "The goals of those with short lifespans may be very different from those with longer lifespans."
These recommendations are similar to those for residential care facilities in Australia and the ones made by The Society for Post-Acute and Long-Term Care Medicine in the U.S, the authors point out.
"The document is an excellent guide on how to identify patients at risk, who should be treated and how," said Dr. Gustavo Duque, director of the Musculoskeletal Ageing Research Program at the University of Sydney in Australia.
Doctors often reduce medications for residents who are admitted to nursing homes without realizing that those with osteoporosis or previous fractures are more likely to suffer a fracture at their new residence than in the community, Duque, who was not part of the new guideline, told Reuters Health by email.
"Ceasing osteoporosis treatment has demonstrated to increase the risk of fractures," Duque said. "Unfortunately we see that situation every day."
Older people who have suffered a fracture in the past should let their provider know, which will trigger an assessment for fracture risk, Papaioannou said.
"Another important point is that if your parent or grandparent has had a fracture, keep in mind it runs in families," she said.