Patterns of oral bisphosphonate deprescribing in older nursing home residents with dementia

• Published in: Osteoporosis international 2022-02, Vol.33 (2), p.379-390
• Main Authors: Niznik, Joshua D., Aspinall, Sherrie L., Hanson, Laura C., Gilliam, Meredith A., Li, Xintong, Kelley, Casey J., Thorpe, Carolyn T.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Bisphosphonates; Dementia; Dementia - drug therapy; Dementia disorders; Deprescriptions; Diphosphonates - therapeutic use; Endocrinology; Female; Humans; Medicare; Medicine; Medicine & Public Health; Mobility; Nursing Homes; Original Article; Orthopedics; Osteoporosis; Regression analysis; Reproducibility of Results; Retrospective Studies; Rheumatology; United States - epidemiology
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-021-06141-9

Summary In a national sample of Medicare nursing home residents with dementia treated with bisphosphonates, 20% had bisphosphonates deprescribed. Residents with clinical characteristics representing decreased likelihood for long-term benefit were more likely to have bisphosphonates deprescribed. Future studies are needed to evaluate outcomes of deprescribing bisphosphonates in this population. Introduction To determine incidence of deprescribing bisphosphonates among nursing home (NH) residents with dementia and identify factors associated with deprescribing. Methods 2015–2016 Medicare claims, Part D prescriptions, Minimum Data Set (MDS) 3.0, and Nursing Home Compare for non-skilled NH residents aged 65 + with dementia and prescriptions for oral bisphosphonates overlapping the first 14 days of the stay. Our primary definition for deprescribing was a 90-day gap in medication supply; we also explored the reliability of different deprescribing definitions (30-, 90-, 180-day gaps). We estimated associations of NH, provider, and resident characteristics with deprescribing bisphosphonates using competing risks regression models. Results Most NH residents with dementia treated with bisphosphonates ( n  = 5312) were ≥ 80 years old (72%), white (81%), and female (90%); about half were dependent for transfers (50%) or mobility (45%). Using a 90-day gap in supply, the 180-day cumulative incidence of deprescribing bisphosphonates was 14.8%. This increased to 32.1% using a 30-day gap and decreased to 11.7% using a 180-day gap. Factors associated with increased likelihood for bisphosphonate deprescribing were age ≥ 90 years, newly admitted (vs. prevalent stay), dependent for mobility, swallowing difficulty, > 1 hospitalization in the prior year, CCRC facility, and nurse practitioner primary provider (vs. physician). Cancer and western geographic region were associated with reduced likelihood for deprescribing. Conclusion In a national sample of NH residents with dementia, bisphosphonate deprescribing was uncommon, and associated with clinical characteristics signifying poor prognosis and decreased likelihood for long-term benefit. Future studies should evaluate clinical outcomes of deprescribing bisphosphonates in this population.