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Osteoporosis Prescribing in Long-Term Care: Impact of a Provincial Knowledge Translation Strategy*

Published online by Cambridge University Press:  08 April 2015

Courtney C. Kennedy ,
George Ioannidis ,
Lehana Thabane ,
Jonathan D. Adachi ,
Denis O’Donnell ,
Lora M. Giangregorio ,
Laura E. Pickard  and
Alexandra Papaioannou
Courtney C. Kennedy
Affiliation:
Department of Medicine, McMaster University St. Peter’s Hospital, GERAS Centre
George Ioannidis
Affiliation:
Department of Medicine, McMaster University St. Peter’s Hospital, GERAS Centre
Lehana Thabane
Affiliation:
Clinical Epidemiology and Biostatistics, McMaster University St Joseph’s Healthcare – Hamilton
Jonathan D. Adachi
Affiliation:
Department of Medicine, McMaster University St Joseph’s Healthcare – Hamilton Alliance for Better Bone Health Chair in Rheumatology
Denis O’Donnell
Affiliation:
Medical Pharmacies Group Limited
Lora M. Giangregorio
Affiliation:
Department of Kinesiology, University of Waterloo
Laura E. Pickard
Affiliation:
Department of Medicine, McMaster University St. Peter’s Hospital, GERAS Centre
Alexandra Papaioannou*
Affiliation:
Department of Medicine, McMaster University St. Peter’s Hospital, GERAS Centre Eli Lilly Canada Chair in Osteoporosis
*
†La correspondance et les demandes de tirés-à-part doivent être adressées à: / Correspondence and requests for offprints should be sent to: Alexandra Papaioannou, BScN, MD, MSc, FRCP (C), FACP McMaster University – Medicine Division of Geriatrics St. Peter’s Hospital 88 Maplewood Avenue GERAS Centre Hamilton, ON L8M 1W9 (papaioannou@hhsc.ca)
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Abstract

This study described prescribing trends before and after implementing a provincial strategy aimed at improving osteoporosis and fracture prevention in Ontario long-term care (LTC) homes. Data were obtained from a pharmacy provider for 10 LTC homes in 2007 and 166 homes in 2012. We used weighted, multiple linear regression analyses to examine facility-level changes in vitamin D, calcium, and osteoporosis medication prescribing rates between 2007 and 2012. After five years, the estimated increase in vitamin D, calcium, and osteoporosis medication prescribing rates, respectively, was 38.2 per cent (95% confidence interval [CI]: 29.0, 47.3; p < .001), 4.0 per cent (95% CI: –3.9, 12.0; p = .318), and 0.2 per cent (95% CI: –3.3, 3.7; p = .91). Although the study could not assess causality, findings suggest that wide-scale knowledge translation activities successfully improved vitamin D prescribing rates, although ongoing efforts are needed to target homes with low uptake.

Résumé

Cette étude décrit les tendances de prescrire avant et après la mise en œuvre d'une stratégie provinciale visant à améliorer la prévention de l'ostéoporose et de la fracture dans les foyers de soins de longue durée (SLD) de l'Ontario. Les données ont été obtenues à partir d'une pharmacie qui a fourni pour 10 centres de SLD en 2007 et 166 foyers en 2012. Nos analyses ont utilisés la régression linéaire multiple et pondérée pour examiner les changements dans les niveaux ou les taux de prescriptions dans les établissements pour la vitamine D, le calcium et les médicaments pour l'ostéoporose de 2007 à 2012. Après cinq ans, l'augmentation des taux estimés pour la prescription de vitamine D, calcium et les médicaments pour l'ostéoporose, respectivement, était de 38,2 pour cent, 4 pour cent et 0,2 pour cent. Bien que l'étude n'a pas évalué la causalité, les résultats suggèrent que les activités à grande échelle dans le transfert des connaissances ont effectué des taux ameliorés de la prescription de vitamine D, bien que des efforts continus sont nécessaires pour cibler les foyers don’t les capacités de traduire les connaissances en pratique sont faibles.

Keywords

agingcalciumlong-term carenursing homeosteoporosisprescribingvitamin Dvieillissmentcalciumsoins de longue duréefoyers de soins infirmiersl'ostéoporose
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 34 , Issue 2 , June 2015 , pp. 137 - 148
Copyright
Copyright © Canadian Association on Gerontology 2015 

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Footnotes

*

We thank the Ministry of Health and Long-Term Care in Ontario for their support of the Ontario Osteoporosis Strategy.

References

Bischoff-Ferrari, H. A., Dietrich, T., Orav, E. J., & Dawson-Hughes, B. (2004a). Positive association between 25-hydroxy vitamin D levels and bone mineral density: A population-based study of younger and older adults. American Journal of Medicine, 116(9), 634–639.CrossRefGoogle ScholarPubMed
Bischoff-Ferrari, H. A., Dietrich, T., Orav, E. J., Hu, F. B., Zhang, Y., Karlson, E. W., et al. (2004b). Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y. American Journal of Clinical Nutrition, 80(3), 752–758.CrossRefGoogle ScholarPubMed
Bischoff-Ferrari, H. A., Giovannucci, E., Willett, W. C., Dietrich, T., & Dawson-Hughes, B. (2006). Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. American Journal of Clinical Nutrition, 84(1), 18–28.CrossRefGoogle ScholarPubMed
Bischoff-Ferrari, H. A., Kiel, D. P., Dawson-Hughes, B., Orav, J. E., Li, R., & Spiegelman, D. (2009). Dietary calcium and serum 25-hydroxyvitamin D status in relation to BMD among U.S. adults. The Official Journal of the American Society of Bone and Mineral Restoration, 24(5), 935–942.CrossRefGoogle ScholarPubMed
Bolland, M. J., Avenell, A., Baron, J. A., Grey, A., MacLennan, G. S., Gamble, G. D., et al. (2010). Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: Meta-analysis. British Medical Journal, 341(c3691), 1–9.CrossRefGoogle ScholarPubMed
Brown, J. P., & Josse, R. G. (2002). 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Canadian Medical Association Journal, 167(10 Suppl), S1–S34.Google ScholarPubMed
Cauley, J. A., Danielson, M. E., Boudreau, R., Barbour, K. E., Horwitz, M. J., Bauer, D. C., et al. (2011). Serum 25-hydroxyvitamin D and clinical fracture risk in a multiethnic cohort of women: The women's health initiative (WHI). The Official Journal of the American Society of Bone and Mineral Research, 26(10), 2378–2388.CrossRefGoogle Scholar
Chapuy, M. C., Arlot, M. E., Duboeuf, F., Brun, J., Crouzet, B., Arnaud, S., et al. (1992). Vitamin D3 and calcium to prevent hip fractures in the elderly women. New England Journal of Medicine, 327(23), 1637–1642.CrossRefGoogle ScholarPubMed
Chen, H., Zhou, X., Fujita, H., Onozuka, M., & Kubo, K. Y. (2013). Age-related changes in trabecular and cortical bone microstructure. International Journal of Endocrinology, 2013(2013), 1–9.Google ScholarPubMed
Colon-Emeric, C. S., Casebeer, L., Saag, K., Allison, J., Levine, D., Suh, T. T., et al. (2004). Barriers to providing osteoporosis care in skilled nursing facilities: Perceptions of medical directors and directors of nursing. Journal of the American Medical Directors Association, 5(6), 361–366.CrossRefGoogle ScholarPubMed
Colon-Emeric, C. S., Lekan, D., Utley-Smith, Q., Ammarell, N., Bailey, D., Corazzini, K., et al. (2007a). Barriers to and facilitators of clinical practice guideline use in nursing homes. Journal of the American Geriatrics Society, 55(9), 1404–1409.CrossRefGoogle ScholarPubMed
Colon-Emeric, C. S., Lyles, K. W., Levine, D. A., House, P., Schenck, A., Gorospe, J., et al. (2007b). Prevalence and predictors of osteoporosis treatment in nursing home residents with known osteoporosis or recent fracture. Osteoporosis International, 18(4), 553–559.CrossRefGoogle ScholarPubMed
Comondore, V. R., Devereaux, P. J., Zhou, Q., Stone, S. B., Busse, J. W., Ravindran, N. C., et al. (2009). Quality of care in for-profit and not-for-profit nursing homes: Systematic review and meta-analysis. BMJ, 339(b2732), 1–15.CrossRefGoogle ScholarPubMed
Crilly, R. G., Tanner, D. A., Kloseck, M., & Chesworth, B. M. (2010). Hip fractures in long-term care: Is the excess explained by the age and gender distribution of the residents? Journal of Aging Research, 2010 (291258), 1–5.CrossRefGoogle ScholarPubMed
Curtis, J. R., Arora, T., Xi, J., Silver, A., Allison, J. J., Chen, L., et al. (2009). Do physicians within the same practice setting manage osteoporosis patients similarly? implications for implementation research. Osteoporosis International, 20(11), 1921–1927.CrossRefGoogle ScholarPubMed
Daneman, N., Gruneir, A., Bronskill, S. E., Newman, A., Fischer, H. D., Rochon, P. A., et al. (2013). Prolonged antibiotic treatment in long-term care: Role of the prescriber. JAMA International Medicine, 173(8), 673–682.CrossRefGoogle ScholarPubMed
Dawson-Hughes, B. (2008). Serum 25-hydroxyvitamin D and functional outcomes in the elderly. American Journal of Clinical Nutrition, 88(2), 537S–540S.CrossRefGoogle ScholarPubMed
Demontiero, O., Herrmann, M., & Duque, G. (2011). Supplementation with vitamin D and calcium in long-term care residents. Journal of the American Medical Directors Association, 12(3), 190–194.CrossRefGoogle ScholarPubMed
Flicker, L., Mead, K., MacInnis, R. J., Nowson, C., Scherer, S., Stein, M. S., et al. (2003). Serum vitamin D and falls in older women in residential care in Australia. Journal of the American Geriatrics Society, 51(11), 1533–1538.CrossRefGoogle ScholarPubMed
Ensrud, K.E., Ewing, S.K., Taylor, B.C., Fink, H.A., Stone, K.L., Cauley, J.A., et al. (2007). Frailty and risk of falls, fracture, and mortality in older women: The study of osteoporotic fractures. Journal of Gerontology A: Biological Science Medical Science, 62(7), 744–751.Google ScholarPubMed
Ensrud, K.E., Ewing, S.K., Cawthon, P.M., Fink, H.A., Taylor, B.C., Cauley, J.A., et al. (2009). A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. Journal of the American Geriatric Society, 57(3), 492–498.CrossRefGoogle Scholar
Frisoli, A. Jr., Chaves, P. H., Ingham, S. J., & Fried, L. P. (2011). Severe osteopenia and osteoporosis, sarcopenia, and frailty status in community-dwelling older women: Results from the women’s health and aging study (WHAS) II. Bone, 48(4), 952–957.CrossRefGoogle ScholarPubMed
Giangregorio, L. M., Jantzi, M., Papaioannou, A., Hirdes, J., Maxwell, C. J., & Poss, J. W. (2009). Osteoporosis management among residents living in long-term care. Osteoporosis International, 20(9), 1471–1478.CrossRefGoogle ScholarPubMed
Giangregorio, L. M., Papaioannou, A., Cranney, A., Zytaruk, N., & Adachi, J. D. (2006). Fragility fractures and the osteoporosis care gap: An international phenomenon. Seminars in Arthritis and Rheumatism, 35(5), 293–305.CrossRefGoogle ScholarPubMed
Gielen, E., Verschueren, S., O’Neill, T. W., Pye, S. R., O’Connell, M. D., Lee, D. M., et al. (2012). Musculoskeletal frailty: A geriatric syndrome at the core of fracture occurrence in older age. Calcified Tissue International, 91(3), 161–177.CrossRefGoogle ScholarPubMed
Gloth, F. M., & Simonson, W. (2008). Osteoporosis is underdiagnosed in skilled nursing facilities: A large-scale heel BMD screening study. Journal of the American Medical Directors Association, 9(3), 190–193.CrossRefGoogle ScholarPubMed
Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: Effective implementation of change in patients’ care. Lancet, 362(9391), 1225–1230.CrossRefGoogle ScholarPubMed
Grol, R. (2010). Has guideline development gone astray? Yes. BMJ, 340, c306.CrossRefGoogle ScholarPubMed
Gupta, G., & Aronow, W. S. (2003). Underuse of procedures for diagnosing osteoporosis and of therapies for osteoporosis in older nursing home residents. Journal of the American Medical Directors Association, 4(4), 200–202.CrossRefGoogle ScholarPubMed
Hanley, D. A., Cranney, A., Jones, G., Whiting, S. J., & Leslie, W. D. (2010). Guidelines Committee of the Scientific Advisory Council of Osteoporosis Canada. Vitamin D in adult health and disease: A review and guideline statement from osteoporosis Canada (summary). Canadian Medical Association Journal, 182(12), 1315–1319.CrossRefGoogle ScholarPubMed
Hardin, J. W., & Hilbe, J. M. (2003). Generalized estimating equations (1st ed.), New York, NY: Chapman & Hall/CRC.Google Scholar
Holvik, K., Ahmed, L. A., Forsmo, S., Gjesdal, C. G., Grimnes, G., Samuelsen, S. O., et al. (2013). Low serum levels of 25-hydroxyvitamin D predict hip fracture in the elderly. A NOREPOS study. The Journal of Clinical Endocrinology and Metabolism, 98(9), 3341–3350.CrossRefGoogle ScholarPubMed
Huybrechts, K. F., Rothman, K. J., Brookhart, M. A., Silliman, R. A., Crystal, S., Gerhard, T., et al. (2012). Variation in antipsychotic treatment choice across US nursing homes. Journal of Clinical Psychopharmacology, 32(1), 11–17.CrossRefGoogle ScholarPubMed
Ioannidis, G., Kennedy, C. C., Dykeman, J., Dudziak, S., & Papaioannou, A. (2012a). Association between vitamin D3 supplementation and serum 25-hydroxyvitamin D levels in older individuals residing in long-term care in Ontario, Canada. Journal of the American Geriatrics Society, 60(5), 985–987.CrossRefGoogle ScholarPubMed
Ioannidis, G., Papaioannou, A., Kennedy, C. C., Giangregorio, L. M., Thabane, L., & Eappen, J., (2012b). What organizational factors influence vitamin D use in nursing homes? Baseline data from the ViDOS cluster randomized controlled trial. Journal of Bone and Mineral Research, 27(Suppl 1). Retrieved 17 February 2015 from http://www.asbmr.org/education/2012-abstracts.Google Scholar
Jachna, C. M., Shireman, T. I., Whittle, J., Ellerbeck, E. F., & Rigler, S. K. (2005). Differing patterns of antiresorptive pharmacotherapy in nursing facility residents and community dwellers. Journal of the American Geriatrics Society, 53(8), 1275–1281.CrossRefGoogle ScholarPubMed
Jaglal, S. B., Hawker, G., Cameron, C., Canavan, J., Beaton, D., Bogoch, E., et al. (2010). The ontario osteoporosis strategy: Implementation of a population-based osteoporosis action plan in Canada. Osteoporosis International, 21(6), 903–908.CrossRefGoogle ScholarPubMed
Kamel, H. K. (2007). Update on osteoporosis management in long-term care: Focus on bisphosphonates. Journal of the American Medical Directors Association, 8(7), 434–440.CrossRefGoogle ScholarPubMed
Kanwar, A., Singh, M., Lennon, R., Ghanta, K., McNallan, S. M., & Roger, V. L. (2013). Frailty and health-related quality of life among residents of long-term care facilities. Journal of Aging and Health, 25(5), 792–802.CrossRefGoogle ScholarPubMed
Kennedy, C. C., Campbell, G., Garg, A. X., Dolovich, L., Stroud, J. B., McCallum, R. E., et al. (2011a). Piloting a renal drug alert system for prescribing to residents in long-term care. Journal of the American Geriatrics Society, 59(9), 1757–1759.CrossRefGoogle ScholarPubMed
Kennedy, C. C., Papaioannou, A., Ioannidis, G., Giangregorio, L. M., Marr, S., Morin, S.N., et al. (2011b). How can we improve bone health in the long-term care setting? lessons from the ViDOS study. Journal of Bone and Mineral Research, 26(Suppl 1). Retrieved 17 February 2015 from http://www.asbmr.org/education/2011-abstracts.Google Scholar
Kennedy, C. C., Ioannidis, G., Giangregorio, L. M., Adachi, J. D., Thabane, L., Morin, S. N., et al. (2012a). An interdisciplinary knowledge translation intervention in long-term care: Study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial. Implementation Science, 7(1), 1–12.CrossRefGoogle ScholarPubMed
Kennedy, C. C., Lohfeld, L., Adachi, J. D., Morin, S. M., Marr, S., & Crilly, R. G., (2013). Is a multifaceted knowledge translation intervention feasible and acceptable in long-term care? A qualitative study with ViDOS participants. Canadian Geriatrics Journal, 16(2).67Google Scholar
Kennedy, C. C., Papaioannou, A., Ioannidis, G., Giangregorio, L. M., Thabane, L., & Soleas, I. (2012b). What predicts osteoporosis treatment in nursing home residents: Baseline data from the ViDOS cluster randomized controlled trial. Journal of Bone and Mineral Research, 27(Suppl 1). Retrieved 17 February 2015 fromhttp://www.asbmr.org/education/2012-abstracts.Google Scholar
Landi, F., Liperoti, R., Fusco, D., Mastropaolo, S., Quattrociocchi, D., Proia, A., et al. (2012). Prevalence and risk factors of sarcopenia among nursing home older residents. Journal of Gerontology: Series A: Biological Sciences and Medical Sciences, 67(1), 48–55.CrossRefGoogle ScholarPubMed
Lau, A. N., Ioannidis, G., Potts, Y., Giangregorio, L. M., Van der Horst, M. L., Adachi, J. D., et al. (2010). What are the beliefs, attitudes and practices of front-line staff in long-term care (LTC) facilities related to osteoporosis awareness, management and fracture prevention? BMC Geriatrics, 10(73), 1–7.CrossRefGoogle ScholarPubMed
Lengyel, C. O., Whiting, S. J., & Zello, G. A. (2008). Nutrient inadequacies among elderly residents of long-term care facilities. Canadian Journal of Dietary Practice Research, 69(2), 82–88.CrossRefGoogle ScholarPubMed
Leslie, W. D., Berger, C., Langsetmo, L., Lix, L. M., Adachi, J. D., Hanley, D. A., et al. (2011a). Construction and validation of a simplified fracture risk assessment tool for Canadian women and men: Results from the CaMos and Manitoba cohorts. Osteoporosis International, 22(6), 1873–1883.CrossRefGoogle ScholarPubMed
Leslie, W. D., Giangregorio, L. M., Yogendran, M., Azimaee, M., Morin, S., Metge, C., et al. (2012). A population-based analysis of the post-fracture care gap 1996–2008: The situation is not improving. Osteoporosis International, 23(5), 1623–1629.CrossRefGoogle Scholar
Leslie, W. D., Lix, L. M., Johansson, H., Oden, A., McCloskey, E., & Kanis, J. A. (2010). Independent clinical validation of a Canadian FRAX tool: Fracture prediction and model calibration. Journal of Bone Mineral Research, 25(11), 2350–2358.CrossRefGoogle ScholarPubMed
Leslie, W. D., Lix, L. M., Langsetmo, L., Berger, C., Goltzman, D., Hanley, D. A., et al. (2011b). Construction of a FRAX(R) model for the assessment of fracture probability in Canada and implications for treatment. Osteoporosis International, 22(3), 817–827.CrossRefGoogle Scholar
Looker, A. C., & Mussolino, M. E. (2008). Serum 25-hydroxyvitamin D and hip fracture risk in older U.S. white adults. Journal of Bone and Mineral Research, 23(1), 143–150.CrossRefGoogle Scholar
McGregor, M. J., Cohen, M., McGrail, K., Broemeling, A. M., Adler, R. N., Schulzer, M., et al. (2005). Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter? Canadian Medical Association Journal, 172(5), 645–649.CrossRefGoogle ScholarPubMed
McGregor, M. J., Cohen, M., Stocks-Rankin, C. R., Cox, M. B., Salomons, K., McGrail, K. M., et al. (2011). Complaints in for-profit, non-profit and public nursing homes in two Canadian provinces. Open Medicine, 5(4), e183–e192.Google ScholarPubMed
McKercher, H. G., Crilly, R. G., & Kloseck, M. (2000). Osteoporosis management in long-term care. survey of Ontario physicians. Canadian Family Physician, 46, 2228–2235.Google ScholarPubMed
Norris, M. A., Walton, R. E., Patterson, C. J. S., Feightner, J. W., & the Canadian Task Force on Preventive Health Care. (2003). Prevention of falls in long-term care facilities: Systematic review and recommendations. London, ON: Canadian Task Force. Report No.: CTFPHC Technical Report.Google Scholar
Ontario Ministry of Health and Long-Term Care. (2013). Home, community and residential care services for seniors: Seniors’ care: Long-term care homes. Ontario, Canada: Queen’s Printer for Ontario. Retrieved 19 January 2014, from http://www.health.gov.on.ca/en/public/programs/ltc/15_facilities.aspx.Google Scholar
Osteoporosis Action Plan Committee. (2003). Osteoporosis action plan: An osteoporosis strategy for Ontario.Google Scholar
Papaioannou, A., Giangregorio, L., Kvern, B., Boulos, P., Ioannidis, G., & Adachi, J, , D. (2004). The osteoporosis care gap in Canada. BMC Musculoskeletal Disorder, 5(11), 1–6.CrossRefGoogle ScholarPubMed
Papaioannou, A., Kennedy, C. C., Campbell, G., Stroud, J. B., Wang, L., Dolovich, L., et al. (2010a). A team-based approach to warfarin management in long term care: A feasibility study of the MEDeINR electronic decision support system. BMC Geriatrics, 10(38), 1–10.CrossRefGoogle ScholarPubMed
Papaioannou, A., Kennedy, C. C., Ioannidis, G., Gao, Y., Sawka, A. M., Goltzman, D., et al. (2008). The osteoporosis care gap in men with fragility fractures: The Canadian multicentre osteoporosis study. Osteoporosis International, 19(4), 581–587.CrossRefGoogle ScholarPubMed
Papaioannou, A., Morin, S., Cheung, A. M., Atkinson, S., Brown, J. P., Feldman, S., et al. (2010b). Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Summary. CMAJ, 182(17), 1864–1873.CrossRefGoogle ScholarPubMed
Parikh, S., Avorn, J., & Solomon, D. H. (2009). Pharmacological management of osteoporosis in nursing home populations: A systematic review. Journal of the American Geriatrics Society, 57(2), 327–334.CrossRefGoogle ScholarPubMed
Parikh, S., Brookhart, M. A., Stedman, M., Avorn, J., Mogun, H., & Solomon, D. H. (2011). Correlations of nursing home characteristics with prescription of osteoporosis medications. Journal of Bone and Mineral Research, 48(5), 1164–1168.Google ScholarPubMed
Parikh, S., Mogun, H., Avorn, J., & Solomon, D. H. (2008). Osteoporosis medication use in nursing home patients with fractures in 1 US state. Archives of Internal Medicine, 168(10), 1111–1115.CrossRefGoogle ScholarPubMed
Rochon, P. A. (2007). Exploring the variation in Ontario nursing home prescribing rates for antipsychotics. Healthcare Quarterly, 10(4), 20–22.CrossRefGoogle ScholarPubMed
Rojas-Fernandez, C. H., Lapane, K. L., MacKnight, C., & Howard, K. A. (2002). 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. Endocrine Practice, 8(5), 335–342.CrossRefGoogle ScholarPubMed
Sawka, A. M., Ismaila, N., Cranney, A., Thabane, L., Kastner, M., Gafni, A., et al. (2010a). A scoping review of strategies for the prevention of hip fracture in elderly nursing home residents. PLoS One, 5(3), 1–10.CrossRefGoogle ScholarPubMed
Sawka, A. M., Ismaila, N., Raina, P., Thabane, L., Straus, S., Adachi, J. D., et al. (2010b). Hip fracture prevention strategies in long-term care: A survey of Canadian physicians’ opinions. Canadian Family Physician, 56(11), e392–e397.Google ScholarPubMed
Viveky, N., Toffelmire, L., Thorpe, L., Billinsky, J., Alcorn, J., Hadjistavropoulos, T., et al. (2012). Use of vitamin and mineral supplements in long-term care home residents. Applied Physiology Nutrition and Metabolism, 37(1), 100–105.CrossRefGoogle ScholarPubMed
Wall, M., Lohfeld, L., Giangregorio, L., Ioannidis, G., Kennedy, C. C., Moser, A., et al. (2013). Fracture risk assessment in long-term care: A survey of long-term care physicians. BMC Geriatrics, 13(109), 1–7.CrossRefGoogle ScholarPubMed
Wright, R. M. (2007). Use of osteoporosis medications in older nursing facility residents. Journal of the American Medical Directors Association, 8(7), 453–457.CrossRefGoogle ScholarPubMed
Yanamadala, M., Heflin, M. T., White, H. K., & Buhr, G. T. (2012). Ensuring vitamin D supplementation in nursing home patients – A quality improvement project. Journal of Nutrition in Gerontology and Geriatrics, 31(2), 158–171.CrossRefGoogle ScholarPubMed
Zimmerman, S. I., Girman, C. J., Buie, V. C., Chandler, J., Hawkes, W., Martin, A., et al. (1999). The prevalence of osteoporosis in nursing home residents. Osteoporosis International, 9(2), 151–157.CrossRefGoogle ScholarPubMed