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Teriparatide Treatment in Nursing Home Residents: A Retrospective Case–Control Study

2016; Wiley; Volume: 64; Issue: 4 Linguagem: Inglês

10.1111/jgs.14073

1532-5415

Rui Niimi, Toshibumi Kono, Atsushi Nishihara, Masahiro Hasegawa, Akihiko Matsumine, Toshihiko Kono, Akihiro Sudo,

Nutrition and Health in Aging

To the Editor: Residence in a nursing home (NH) is associated with activity of daily living (ADL) disability, high mortality, and high healthcare costs. Several studies have emphasized the high prevalence of osteoporosis and risk of falls and osteoporotic fracture in individuals with ADL disability, especially NH residents, and thereby advocate osteoporosis treatment.1 Little is known about the effects of osteoporosis medication on NH residents. The effect of daily teriparatide treatment in elderly NH residents was studied. This retrospective case–control study (1:2) enrolled 47 NH residents at one NH and 94 community-dwelling controls matched for age, sex, and ADL ability. Teriparatide 20 μg/d was administered to all participants for 24 months. Participants were characterized as having low (requires assistance with all ADLs, living with a caregiver, requires a frame or wheelchair for mobilization), moderate (requires some assistance with ADLs and a walker for mobilization), and high (requires no assistance with ADLs, functions independently, and can mobilize over significant distances) functioning.2 The outcome of interest was the effect of teriparatide treatment on ADL ability, so high-functioning controls were matched with NH residents (inverse matching). Age, sex, body mass index, bone mineral density (BMD) of the lumbar spine (LS; L1–L4) and femoral neck (FN), and procollagen type I N-terminal propeptide (PINP) concentration did not differ significantly between the two groups. BMD was measured using dual-energy X-ray absorptiometry, and serum PINP concentration was measured at baseline and 4, 12, and 24 months after starting treatment. Additional details regarding these methods have been published elsewhere.3-5 Longitudinal BMD changes in each group were determined using a paired t-test. Data normality was assessed using the chi-square test for goodness of fit. Longitudinal changes in serum PINP after starting treatment were assessed using a paired t-test. All hypotheses were tested at a two-sided 5% significance level. Differences in categorical variables were assessed using the chi-square test and Fisher exact test. Twenty-seven (57%) NH residents and 49 (52%) controls who completed the 24-month teriparatide treatment course were analyzed. Twenty-two NH residents (43%) and 45 controls (48%) discontinued teriparatide treatment. There were no differences in completion rate between NH residents and controls (P = .87; chi-square test). Four of the 27 NH residents (15%) were moderate functioning and 23 (85%) were low functioning. Thirty-nine of the 49 controls (80%) were high functioning, six (12%) were moderate functioning, and four (8%) were low functioning. LS BMD increased significantly in both groups (mean increase: NH residents, 15.3 ± 8.3%, 95% confidence interval (CI) = 12.2–18.8%; controls, 13.4 ± 10.2%, 95% CI=0.6–16.3%; 1.9 percentage points, 95% CI = −2.7–6.5 percentage points more in NH residents than in controls) (Figure 1). FN BMD also increased significantly in both groups (mean increase: NH residents, 8.4 ± 11.9%, 95% CI = 3.7–13.2%; controls, 4.4 ± 8.7%, 95% CI = 2.0–6.8%; 4.0 percentage points, 95% CI = −0.8–8.9% percentage points more in NH residents than controls). The difference in the absolute increase in LS BMD between NH residents and controls was 0.018 g/cm2 (95% CI = −0.012–0.049 g/cm2; Student t-test), and the in the difference absolute increase in FN BMD between NH residents and control patients was 0.015 g/cm2 (95% CI = −0.008–0.038 g/cm2; Student t-test). Daily teriparatide treatment increased LS and FN BMD similarly in NH residents and controls. The prevalence of osteoporosis is high in NH residents, but which pharmacological agents are effective is unclear.6 It has been reported that alendronate, which was well tolerated, increased LS and FN BMD in long-term care facility residents.7 Another study found that between-meal risedronate 30 mg did not affect bone turnover after 12 weeks in NH residents and therefore would not be expected to increase BMD or reduce risk of fracture.8 Evaluation of bone turnover changes after 12 weeks of raloxifene treatment in 12 female NH residents showed that the effects on bone turnover were comparable with those seen in younger postmenopausal women.9 PINP was found to increase for 12 months after teriparatide treatment in institutionalized individuals.10 The current study is the first to examine the effect of teriparatide on BMD and serum PINP over a 24-month period in NH residents, showed the beneficial effects of teriparatide on BMD and serum PINP in NH residents. The authors thank Koji Fukuda, Hideki Ito, Takeshi Kato, Kana Nakanishi, Kenji Kuroda, Haruyoshi Mizuno, Yohei Takigawa, Yoshifumi Takahashi, Hiroaki Takeuchi, Nobuyuki Tanaka, and Akiko Mizutani for their diligence in preparing the clinical recordings. The authors thank Dr. Hideki Yamamoto and Dr. Takahito Saito for their assistance with osteoporosis screening. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Dr. Niimi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Niimi: concept, design, acquisition of data, analysis and interpretation of data, manuscript preparation. Toshibumi Kono: design, acquisition of data. Nishihara: acquisition of data. Hasegawa, Matsumine: critical revision of manuscript for important intellectual content. Toshihiko Kono: study supervision. Toshihiko Kono: drafting of manuscript. Sponsor's Role: The sponsor was not involved in design, methods, recruitment, data collection, analysis, or manuscript preparation.