Osteoporosis risk management is lacking for women admitted with new fractures to post-acute care facilities — both before they are admitted and after discharge, according to the authors of a new study.
Investigators tracked healthcare resource utilization and costs for more than 388,000 participating Medicare beneficiaries with incident fragility fracture. Participants were admitted to a skilled nursing facility, home health care, inpatient-rehabilitation facility or a long-term acute-care hospital.
The researchers also measured the impact of illness on health-related quality of life (humanistic burden) among skilled nursing facility residents with linked Minimum Data Set assessments. The study period covered January, 2017, through October 17, 2019.
Across all post-acute care settings, there was low use of dual-energy X-ray absorptiometry (DXA) to screen for osteoporosis and of medications to prevent bone loss, both during baseline and following discharge. For example, from 8% to 14% of patients received DXA during baseline and between 5% and 16% received scans following post-acute discharge. Similarly, only 10% to 12% of patients were prescribed osteoporosis medications during baseline.
In addition, hospitalization rates and total costs were significantly higher after discharge from post-acute care for SNF, home-health, inpatient-rehabilitation and long-term acute care patients when compared with baseline, according to E. Michael Lewiecki, MD, of the New Mexico Clinical Research and Osteoporosis Center in Albuquerque, NM, and colleagues.
Dual eligibility for Medicaid was linked to 12% higher costs, with Black patients having 14% higher costs. Hospitalization rates were 3.7 times higher and emergency department visits were 1.3 times higher, resulting in 2.7 times higher costs after a SNF discharge compared with baseline.
Patients showed an improvement of 3.5 points in activities of daily living scores during an SNF stay, but improvements in Black patients were 1.2 points lower than in white patients. Pain intensity scores showed no improvement at -0.8 points.
“Our findings of underutilized medications and DXA scans highlight lack of clinical management of osteoporosis in women at risk for fracture,” the authors wrote.
“Results indicate a need for improved early diagnosis and aggressive disease management to prevent and treat fragility fractures,” they concluded.
The research team included investigators from biotechnology company Amgen and data solutions company Inovalon.
Full findings were published in JAMDA.