Treatment for osteoporosis in Australian residential aged care facilities: consensus recommendations for fracture prevention

Gustavo Duque, Jacqueline J Close, Julien P de Jager, Peter R Ebeling, Charles Inderjeeth, Stephen Lord, Andrew J McLachlan, Ian R Reid, Bruce R Troen and Philip N Sambrook
Med J Aust 2010; 193 (3): 173-179.


  • Gustavo Duque1
  • Jacqueline J Close2
  • Julien P de Jager3
  • Peter R Ebeling4
  • Charles Inderjeeth5
  • Stephen Lord2
  • Andrew J McLachlan6
  • Ian R Reid7
  • Bruce R Troen8
  • Philip N Sambrook9

  • 1 Ageing Bone Research Program, Sydney Medical School – Nepean Campus, University of Sydney, Sydney, NSW.
  • 2 Prince of Wales Medical Research Institute, University of New South Wales, Sydney, NSW.
  • 3 Gold Coast Rheumatology, Gold Coast, QLD.
  • 4 Department of Medicine, Western Hospital, University of Melbourne, Melbourne, VIC.
  • 5 Area Rehabilitation and Aged Care, National Institute of Clinical Studies and University of Western Australia, Perth, WA.
  • 6 Faculty of Pharmacy, University of Sydney and Centre for Education and Research in Ageing, Sydney, NSW.
  • 7 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
  • 8 Department of Geriatric Medicine, Miller School of Medicine, University of Miami, Miami, Fla, USA.
  • 9 Kolling Institute for Medical Research, Sydney Medical School – Northern Campus, University of Sydney, Sydney, NSW.



The Consensus Conference was endorsed as a continuing medical education activity by the Royal Australian College of General Practitioners. The Australian and New Zealand Bone and Mineral Society and Osteoporosis Australia endorsed the Consensus Conference. The Consensus Conference was funded with an unrestricted educational grant from Novartis Australia and a grant from the Nepean Medical Research Foundation.

Competing interests:

Ian Reid received money, as a board member, from Novartis, Merck, Sanofi-Aventis and Amgen. His employing institution received grants from Novartis, Merck, Amgen, and Procter and Gamble. He received honoraria from Merck, Amgen and Novartis. Stephen Lord received consulting fees and support for travel expenses, as an unrestricted grant, from Novartis Pharmaceuticals Australia. Peter Ebeling’s employing institution received an honorarium and support for travel expenses from Novartis. He received fees for review activities, including payment for reviewing this article and support in kind, from Novartis. His employing institution received money for his board membership of Merck, Amgen and Sanofi-Aventis and grants from Novartis, Amgen and Merck. Julien de Jager received an honorarium from Novartis for chairing a small group. Jacqueline Close’s employing institution received honoraria from Novartis for coordinating a workshop and she received support for accommodation and meal expenses for a night. Gustavo Duque’s employing institution received money from Novartis and the Nepean Medical Research Foundation, and he received a consulting fee from Novartis. He has been paid money as a board member of Procter and Gamble Pharmaceuticals and his employing institution received a research grant from Novartis.

  • 1. Australian Bureau of Statistics. A picture of a nation. Population overview. Canberra: ABS, 2009. (ABS Cat. No. 2070.0.) 0Publication29.01.096/$File/20700_Population_overview.pdf (accessed Jun 2010).
  • 2. Australian Institute of Health and Welfare. Residential aged care in Australia 2007–08. Canberra: AIHW, 2009. (AIHW Cat No. AGE 58.) (accessed Jul 2010).
  • 3. Handler SM, Wright RM, Ruby CM, Hanlon JT. Epidemiology of medication-related adverse events in nursing homes. Am J Geriatr Pharmacother 2006; 4: 264-272.
  • 4. Bain KT, Holmes HM, Beers MH, et al. Discontinuing medications: a novel approach for revising the prescribing stage of the medication-use process. J Am Geriatr Soc 2008; 56: 1946-1952.
  • 5. Colón-Emeric C, Lyles KW, Levine DA, et al. Prevalence and predictors of osteoporosis treatment in nursing home residents with known osteoporosis or recent fracture. Osteoporos Int 2007; 18: 553-559.
  • 6. Jachna C, Shireman T, Whittle J, et al. Differing patterns of antiresorptive pharmacotherapy among nursing facility residents and community dwellers. J Am Geriatr Soc 2005; 53: 1275-1281.
  • 7. Kamel H. Underutilization of calcium and vitamin D supplements in an academic long-term care facility. J Am Med Dir Assoc 2004; 5: 98-100.
  • 8. Rojas-Fernandez C, Lapane K, MacKnight C, Howard K. Undertreatment of osteoporosis in residents of nursing homes: population based study with use of the Systematic Assessment of Geriatric Drug Use via Epidemiology (SAGE) database. Endocr Pract 2002; 8: 335-342.
  • 9. National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: NHMRC, 1999. (accessed Jun 2010).
  • 10. Chen JS, Simpson JM, March LM, et al. Fracture risk assessment in frail older people using clinical risk factors. Age Ageing 2008; 37: 536-541
  • 11. Australian Institute of Health and Welfare. Carers in Australia. Assisting frail older people and people with a disability. Canberra: AIHW, 2004. (AIHW Cat. No. AGE 41; Aged Care Series No. 8). (accessed Jul, 2010).
  • 12. Parikh S, Avorn J, Solomon DH. Pharmacological management of osteoporosis in nursing home populations: a systematic review. J Am Geriatr Soc 2009; 57: 327-334.
  • 13. Cumming RG. Nursing home residence and risk of hip fracture. Am J Epidemiol 1996; 143: 1191-1194.
  • 14. Norton R, Campbell AJ, Reid IR, et al. Residential status and risk of hip fracture. Age Ageing 1999; 28: 135-139.
  • 15. Black DM, Steinbuch M, Palermo L, et al. An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos Int 2001; 12: 519-528.
  • 16. Burger H, De Laet CE, Weel AE, et al. Added value of bone mineral density in hip fracture risk scores. Bone 1999; 25: 369-374.
  • 17. Dargent-Molina P, Douchin MN, Cormier C, et al. Use of clinical risk factors in elderly women with low bone mineral density to identify women at higher risk of hip fracture: the EPIDOS prospective study. Osteoporos Int 2002; 13: 593-599.
  • 18. McGrother CW, Donaldson MM, Clayton D, et al. Evaluation of a hip fracture risk score for assessing elderly women: the Melton Osteoporotic Fracture (MOF) study. Osteoporos Int 2002; 13: 89-96.
  • 19. Lyles KW, Schenck AP, Colón-Emeric CS. Hip and other osteoporotic fractures increase the risk of subsequent fractures in nursing home residents. Osteoporos Int 2008; 19: 1225-1233.
  • 20. Spector W, Shaffer T, Potter DE, et al. Risk factors associated with the occurrence of fractures in US nursing homes: resident and facility characteristics and prescription medications. J Am Geriatr Soc 2007; 55: 327-333.
  • 21. Rapp K, Lamb SE, Klenk J, et al. Fractures after nursing home admission: incidence and potential consequences. Osteoporos Int 2009; 20: 1775-1783.
  • 22. Kanis JA, Oden A, Johansson H, et al. FRAX and its applications to clinical practice. Bone 2009; 44: 734-743.
  • 23. Nguyen ND, Frost SA, Center JR, et al. Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos Int 2008; 19: 1431-1444.
  • 24. Chen JS, Sambrook PN, Simpson JM, et al. A selection strategy was developed for fracture reduction programs in frail older people. J Clin Epidemiol 2009 Nov 18; [Epub ahead of print].
  • 25. Institute of Bone and Joint Research. Fracture risk calculator. (accessed Jun 2010).
  • 26. Wright RM. Use of osteoporosis medications in older nursing facility residents. J Am Med Dir Assoc 2007; 8: 453-457.
  • 27. Colón-Emeric CS, Lyles KW, House P, et al. Randomized trial to improve fracture prevention in nursing home residents. Am J Med 2007; 120: 886-892.
  • 28. Miles RW. Hip fracture reduction in northwest Arkansas nursing homes. J Am Med Dir Assoc 2008; 9: 449-453.
  • 29. Delbaere K, Close JC, Menz HB, et al. Development and validation of fall risk screening tools for use in residential aged care facilities. Med J Aust 2008; 189: 193-196. <MJA full text>
  • 30. Nishtala PS, Hilmer SN, McLachlan AJ, et al. Impact of residential medication management reviews on drug burden index in aged care homes: a retrospective analysis. Drugs Aging 2009; 26: 677-686.
  • 31. Nishtala PS, McLachlan AJ, Bell JS, Chen TF. Psychotropic prescribing in long-term care facilities: impact of medication reviews and educational interventions. Am J Geriatr Psychiatry 2008; 16: 621-632.
  • 32. Iyer S, Naganathan V, McLachlan AJ, Le Couteur DG. Medication withdrawal trials in people aged 65 years and older: a systematic review. Drugs Aging 2008; 25: 1021-1031.
  • 33. Rapp K, Lamb SE, Büchele G, et al. Prevention of falls in nursing homes: subgroup analyses of a randomized fall prevention trial. J Am Geriatr Soc 2008; 56: 1092-1097.
  • 34. Cameron ID, Murray GR, Gillespie LD, et al. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev 2010; (1): CD005465.
  • 35. Latham NK, Anderson CS, Reid IR. Effects of vitamin D supplementation on strength, physical performance, and falls in older persons: a systematic review. J Am Geriatr Soc 2003; 51: 1219-1222.
  • 36. Schnelle JF, Kapur K, Alessi C, et al. Does an exercise and incontinence intervention save healthcare costs in a nursing home population? J Am Geriatr Soc 2003; 51: 161-168.
  • 37. Zimmerman S, Magaziner J, Birge SJ, et al. Adherence to hip protectors and implications for US long-term care settings J Am Med Dir Assoc 2010; 11: 106-115.
  • 38. Sawka AM, Boulos P, Beattie K, et al. Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis. J Clin Epidemiol 2007; 60: 336-344.
  • 39. Sawka AM, Boulos P, Beattie K, et al. Do hip protectors decrease the risk of hip fracture in institutional and community-dwelling elderly? A systematic review and meta-analysis of randomized controlled trials. Osteoporos Int 2005; 16: 1461-1474.
  • 40. Kiel DP, Magaziner J, Zimmerman S, et al. Efficacy of a hip protector to prevent hip fracture in nursing home residents: the HIP PRO randomized controlled trial. JAMA 2007; 298: 413-422.
  • 41. Schousboe JT, Taylor BC, Fink HA, et al. Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men. JAMA 2007; 298: 629-637.
  • 42. Schousboe JT, Ensrud KE, Nyman JA, et al. Universal bone densitometry screening combined with alendronate therapy for those diagnosed with osteoporosis is highly cost-effective for elderly women. J Am Geriatr Soc 2005; 53: 1697-1704.
  • 43. King MA, Roberts MS. The influence of the Pharmaceutical Benefits Scheme (PBS) on inappropriate prescribing in Australian nursing homes. Pharm World Sci 2007; 29: 39-42.
  • 44. Duque G, Demontiero O, Troen BR. Prevention and treatment of senile osteoporosis and hip fractures. Minerva Med 2009; 100: 79-94.
  • 45. Snowdon J, Day S, Baker W. Audits of medication use in Sydney nursing homes. Age Ageing 2006; 35: 403-408.
  • 46. Przybelski R, Agrawal S, Krueger D, et al. Rapid correction of low vitamin D status in nursing home residents. Osteoporos Int 2008; 19: 1621-1628.
  • 47. Bischoff-Ferrari HA, Willett WC, Wong JB, et al. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 2005; 293: 2257-2264.
  • 48. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effect of vitamin D on falls: a meta-analysis. JAMA 2004; 291: 1999-2006.
  • 49. Bischoff-Ferrari HA, Giovannucci E, Willett WC, et al. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 2006; 84: 18-28.
  • 50. Reid IR, Gallagher DJA, Bosworth J. Prophylaxis against vitamin D deficiency in the elderly by regular sunlight exposure. Age Ageing 1986; 15: 35-40.
  • 51. Tang BM, Eslick GD, Nowson C, et al. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 2007; 370: 657-666.
  • 52. Sanders KM, Nowson CA, Kotowicz MA, et al. Calcium and bone health: position statement for the Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia and the Endocrine Society of Australia. Med J Aust 2009; 190: 316-320. <MJA full text>
  • 53. Pentti K, Tuppurainen MT, Honkanen R, et al. Use of calcium supplements and the risk of coronary heart disease in 52–62-year-old women: the Kuopio Osteoporosis Risk Factor and Prevention Study. Maturitas 2009; 63: 73-78.
  • 54. Chel V, Wijnhoven HA, Smit JH, et al. Efficacy of different doses and time intervals of oral vitamin D supplementation with or without calcium in elderly nursing home residents. Osteoporos Int 2008; 19: 663-671.
  • 55. Greenspan SL, Schneider DL, McClung MR, et al. Alendronate improves bone mineral density in elderly women with osteoporosis residing in long-term care facilities. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2002; 136: 742-746.
  • 56. Inderjeeth CA, Foo AC, Lai MM, Glendenning P. Efficacy and safety of pharmacological agents in managing osteoporosis in the old old: review of the evidence. Bone 2009; 44: 744-751.
  • 57. Kamel HK. Update on osteoporosis management in long-term care: focus on bisphosphonates. J Am Med Dir Assoc 2007; 8: 434-440.
  • 58. McHorney CA, Schousboe JT, Cline RR, et al. The impact of osteoporosis medication beliefs and side-effect experiences on non-adherence to oral bisphosphonates. Curr Med Res Opin 2007; 23: 3137-3152.
  • 59. Lewiecki EM. A clinician’s perspective on the use of zoledronic acid in the treatment of postmenopausal osteoporosis. J Clin Densitom 2008; 11: 478-484.
  • 60. Khosla S, Burr D, Cauley J, et al. American Society for Bone and Mineral Research. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2007; 22: 1479-1491.
  • 61. Loke YK, Jeevanantham V, Singh S. Bisphosphonates and atrial fibrillation: systematic review and meta-analysis. Drug Saf 2009; 32: 219-228.
  • 62. Richards JB, Cherkas LF, Spector TD. An analysis of which anti-osteoporosis therapeutic regimen would improve compliance in a population of elderly adults. Curr Med Res Opin 2007; 23: 293-299.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.