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Identifying Real-World Patterns of Bisphosphonate Deprescribing in Nursing Home Residents with Dementia

Niznik, J.D., Aspinall, S.L., Hanson, L.C. et al. Patterns of Oral Bisphosphonate Deprescribing in Older Nursing Home Residents with Dementia. Osteoporos Int. Sep 2021.

Dr. Niznik and colleagues determines the incidence of deprescribing bisphosphonates among nursing home residents with dementia, and identified factors associated with deprescribing bisphosphonates. Dr. Niznik and team point to the need of addressing the gaps in knowledge about real-world patterns of bisphosphonate deprescribing in nursing home residents with dementia.

Dr. Niznik and colleagues used innovative methods to find instances of deprescribing, and see what predicted deprescribing for a nationally representative sample of older adults in nursing homes. Using data from older adults who are in nursing homes (Minimum Data Set), Medicare claims, Nursing Home Compare and Medicare Part D data and a deprescribing definition of a 90-day gap in medication supply, the 180-day cumulative incidence of deprescribing bisphosphonates was 14.8%.  

Factors associated with increased likelihood for deprescribing included:

  • Age over 90 years
  • Being newly admitted to the nursing home
  • Dependent for mobility
  • Swallowing difficulty
  • Continuing-Care Retirement Communities 
  • Having a nurse practitioner as a primary provider (vs. Physician)

Factors associated with reduced likelihood for deprescribing included:

  • Cancer
  • Residing in the western USA

The clinical characteristics associated with deprescribing suggested decision-making based on prognosis, risk of harm (with swallowing difficulty), and less evidence for benefit.  Most residents continued to take bisphosphonates. They found evidence of organizational-level influence on deprescribing with both provider and facility characteristics predicting deprescribing. The true definition of deprescribing is difficult to determine, but studies like this one investigate the reliability of different deprescribing definitions.

The results from this study create the foundation for future studies to evaluate the outcomes, both risks and benefits, of deprescribing bisphosphonates in a vulnerable population often inadequately represented in research.

Primary author Dr. Joshua Niznik says:

“This study provides meaningful insight into real-world patterns of deprescribing bisphosphonates in the nursing home setting, which was driven by resident-level clinical factors as well as organizational-level influences.  Our study also highlights the need for validation work to explore different definitions for deprescribing when using administrative healthcare data.”

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