Differing patterns of antiresorptive pharmacotherapy in nursing facility residents and community dwellers

OBJECTIVES: Little is known about differences between current patterns of antiresorptive therapy (ART) use in nursing facility (NF) residents and by community-dwelling older adults (CDs). ART use was compared in older NF residents and CDs. DESIGN: Cross-sectional analysis. SETTING: Kansas Medicaid files from May 2000 through April 2001. PARTICIPANTS: Women aged 65 and older having at least 9 months of data as a CD or NF resident. MEASUREMENTS: Pharmacy claims were used to identify any ART prescription, including hormone replacement therapy (HRT), a bisphosphonate, raloxifene, or calcitonin. Demographic and clinical variables were identified from the claims files. Factors associated with ART use in bivariate analyses were entered into logistic regression models. Similar analyses were performed for bisphosphonate use among non-estrogen replacement therapy (non-ERT) ARTs (excluding HRT). RESULTS: The final study sample (N = 2,289) included 898 NF (mean age 85.2) residents and 1,391 CDs (mean age 76.6). CDs were more likely to receive any ART (24.5%) than NF residents (19.6%). After adjustment for potential confounders, NF residents aged 65 to 84 were less likely (odds ratio (OR) = 0.61, 95% confidence interval (CI) = 0.44-0.85) to receive ART than CDs of the same age. Conversely, of those aged 85 and older, NF residents were more likely than CDs to receive ART (OR = 1.96, 95% CI = 1.18-3.25). Calcitonin was the most common non-ERT ART prescribed for NF residents, whereas bisphosphonates were more often prescribed for CDs. CONCLUSION: Underusage of ART is common in NF and CD cohorts. NF residents are less likely to receive bisphosphonates and more likely to receive calcitonin, for which efficacy is less clear. Further research is needed to identify factors influencing ART prescribing and selection of specific ARTs in different settings.