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DO GERIATRIC PATIENTS AT RISK OF FALLS RECEIVE ANTI-OSTEOPOROTIC MEDICATIONS ?
de Sylva C, Jankovic A, Fiorito S, Flores Vivian G, De Breucker S, Kalitventzeff S, Pepersack T.
Introduction: Age-related bone loss begins in the fourth or fifth decades, and results in a slow loss of cortical and trabecular bone in both men and women. This age-related bone loss continues into the 9th and 10th decades in women, and may be partially due to decreased calcium absorption, and may be somewhat attenuated by calcium supplementation, vitamin D, and biphosphonates.
Objectives: To assess at admission and at discharge the anti-osteoporotic medications use of geriatric hospitalized patients according to their bone mass and their risk of falls.
Design: Prospective observational survey.
Methods: The charts consecutive admissions in an acute geriatric unit were prospectively studied by pharmacist trainees between November and December 2005. A list of anti-osteoporotic medications potentially was systematically checked. The risk of falls was assessed using the Stratify score. When the clinicians thought bisphophonates could be administrated, bone mass was measured using dualphotoabsorptiometry to obtain the reimbursement of the drug.
Results: Thirty-four patients (median age 83 yr, range 72-99) were admitted for a median length of stay of 16 days. Sixty-two percents were admitted for a falls and/or were at risk of falls according to the Stratify score. Twenty-nine percents patients presented with hip fracture. The median number of drugs was 6/day (range 1 to 15) at admission and 6.5/day at discharge. Among the 14 patients for whom bone mass was measured, 7% had normal values, 36% presented osteopenia, and 57% presented osteopenia. The three main anti-osteoporotic medications received at admission were respectively: vitamin D (29%), calcium salts (26%) and alendronate (21%). The proportion of patients receiving these treatments not significantly increased at discharge (vitamin D (38%), calcium salts (41%) and alendronate (24%). Patients presenting no risk of falls presented a lower hip bone density (T-score) as compared with those presenting with a risk of fall (T-scores= -3.250+/-1.258 versus -1.875+/-0.834 ; p=0.045).
Discussion: Despite a high prevalence of patients admitted for falls or at risk of falls and a high prevalence of low bone mass, anti-osteoporotic medications remain underused among geriatric patients. Osteoporosis may be present without any risk of falls. A quality program is needed to improve the use of anti-osteoporotic medications for patients admitted in our geriatric unit.
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