ECTS2014 Poster Presentations Osteoporosis: treatment (68 abstracts)
Recommendations for osteoporosis management and fracture prevention for the frail elderly in long-term care
Alexandra Papaioannou 1, , Nancy Santesso 2 , Suzanne Morin 3 , Angela Cheung 4 , Richard Crilly 5 , Lora Giangregorio 6 , Susan Jaglal 7 , Paul Katz 8 , Robert Josse 9 , Sharon Kaasalainen 10 , Andrea Moser 8 , Laura Pickard 1 , Carly Skidmore 1 , Hope Weiler 11 , Susan Whiting 12 , Ravi Jain 13 & Jonathan Adachi 1
1Department of Medicine, McMaster University, Hamilton, Ontario, Canada; 2Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; 3Department of Medicine, McGill University, Montreal, Quebec, Canada; 4Department of Medicine, University of Toronto, Toronto, Ontario, Canada; 5Department of Medicine, University of Western Ontario, London, Ontario, Canada; 6Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada; 7Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; 8Baycrest, Toronto, Ontario, Canada; 9Department of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada; 10School of Nursing, McMaster University, Hamilton, Ontario, Canada; 11Department of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada; 12Department of Nutrition and Dietetics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 13Osteoporosis Canada, Toronto, Ontario, Canada.
Objectives: Clinicians practicing in long-term care (LTC) face unique challenges caring for frail elderly individuals including multiple co-morbidities, polypharmacy, and end of life care, and practice guidelines typically do not address this population. Guidance regarding the management of osteoporosis and fracture prevention in LTC, a high-risk population, is needed.
Materials and methods: A survey of LTC physicians informed key questions and outcomes, and interviews with resident representatives and a literature review informed values and preferences. The GRADE approach was used.
Results: For residents at high risk for fracture, we suggest multifaceted interventions that are individually tailored to reduce the risk of falls and fractures, and suggest balance, strength and functional training exercises only when part of a multifaceted intervention. There may be an increase risk of falls in this high-risk population if risk factors for falls are not addressed in addition to exercise interventions. We recommend hip protectors. We recommend vitamin D3 supplements daily (800–2000 IU) and calcium supplementation up to 500 mg daily if unable to meet recommended dietary allowances through food. We recommend the following therapeutic agents: alendronate, risedronate, zoledronic acid, or denosumab. Teraparatide is a suggested option. We suggest raloxifene and etidronate not be used. For every 1000 persons who are treated for 1 year with the recommended pharmacological therapies there would be 22–24 fewer hip fractures, 89–124 fewer vertebral fractures and 13–18 fewer non vertebral fractures. The evidence which informed these recommendations included adverse effects, patient values and preferences, lifespan and costs.
Conclusions: These are the first guidelines developed for the care of osteoporosis and fracture prevention in LTC using GRADE. In LTC, strategies to prevent fractures and falls must consider resident values and preferences, co-morbidities, life expectancy, and quality of life.
They emailed a full list of disclosures to be included as follows: Dr Alexandra Papaioannou has received grants/research support from Amgen, Eli Lilly, Merck and Warner Chilcott. Dr Papaioannou has been on a speakers bureau and received honoraria from Amgen, Eli Lilly, and Merck. Dr Papaioannou has received consulting fees from Amgen, Eli Lilly and Merck and is an employee of McMaster University. Nancy Santesso, no conflicts. Dr Suzanne Morin, has received grants/research support from Amgen. Dr Morin has received consulting fees for Amgen, Merck and Eli LIlly. Dr Morin has been on speakers bureau and received honoraria from Amgen and Eli Lilly. Dr Angela Cheung has received grants and honorarium from Amgen, Eli Lilly, Merck. Dr Richard Crilly, no conflicts. Dr Lora Giangregorio has received grants/research support from Merck. Kerry Grady, no conflicts. Dr Robert Josse has been an advisory board member, received speaker honoraria and/or research grants from Lilly, Amgen, Novartis, Warner Chilcott, Merck. Dr Susan Jaglal, no conflicts. Ravi Jain, no conflicts. Dr Sharon Kaasalainen, no conflicts. Dr Andrea Moser, no conflicts. Laura, Pickard, no conflicts. Carly Skidmore, no conflicts. Dr Hope Weiler, no conflicts. Dr Susan Whiting, no conflicts. Dr Jonathan Adachi, has participated in clinical trials for Amgen, Eli Lilly, Merck, Novartis. Dr Adachi has been on a speakers bureau, received honoraria and consulting fees from Amgen, Eli Lilly, Merck, Novartis, Warner Chilcott. Dr Adachi is an employee of McMaster University.
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