Prevention of hip fractures in long-term care: relevance of community-derived data

Osteoporosis and falling are two major contributing factors to fractures in older persons; the relevant contribution of these may vary according to age, setting, and frailty. The purpose of this review was to examine the existing evidence on osteoporosis treatments to determine whether participants in clinical trials include or resemble the older and frailer adult population living in long-term care (LTC). The trials (N=50) used to support major Canadian guidelines for osteoporosis treatment were reviewed because these are used to recommend treatment for all older adults, and several more-recent studies were added. Trials conducted specifically with participants living in LTC were also reviewed (N=6). The majority of studies (96.0%) on osteoporosis treatments were conducted with community-dwelling participants, with many excluding participants resembling the LTC population. Mean ages ranged from 52 to 84, although for the majority of studies, the mean age was younger than 70. Similarly, 80.0% of studies conducted in LTC included only residents who were ambulatory, mobile, able to transfer independently, or not permanently bedridden. Mean ages in these studies ranged from 83 to 85. These findings suggest that frail older adults, particularly the oldest and frailest adults in LTC, are neglected in clinical trials of osteoporosis fracture prevention. There is little evidence to support the application of community-based guidelines to the LTC population, and studies directly involving this population are needed. The role of age, frailty, and the mechanics of falls in hip fracture are discussed.