Real-world bone turnover marker use: impact on treatment decisions and fracture.

The use of bone turnover marker (BTM) testing for patients with osteoporosis in the USA has not been well characterized. This retrospective US-based real-world data study found BTM testing has some association with treatment decision-making and lower fracture risk in patients with presumed osteoporosis, supporting its use in clinical practice. INTRODUCTION: The purpose of this study was to characterize bone turnover marker (BTM) testing patterns and estimate their clinical utility in treatment decision-making and fragility fracture risk in patients with osteoporosis using a retrospective claims database. METHODS: Data from patients aged ≥ 50 years with newly diagnosed osteoporosis enrolled in the Truven MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Co-ordination of Benefits databases from January 2008 to June 2018 were included. Osteoporosis was ascertained by explicit claims, fragility fracture events associated with osteoporosis, or prescribed anti-resorptive or anabolic therapy. BTM-tested patients were 1:1 propensity score matched to those untested following diagnosis. Generalized estimating equation models were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for testing versus no testing on both treatment decision-making and fragility fracture. RESULTS: Of the 457,829 patients with osteoporosis, 6075 were identified with ≥ 1 BTM test following diagnosis; of these patients, 1345 had a unique treatment decision made ≤ 30 days from BTM testing. The percentage of patients receiving BTM tests increased significantly each year (average annual % change: + 8.1%; 95% CI: 5.6-9.0; p = 0.01). Patients tested were significantly more likely to have a treatment decision (OR: 1.14; 95% CI: 1.13-1.15), and testing was associated with lower odds of fracture versus those untested (OR: 0.87; 95% CI: 0.85-0.88). CONCLUSION: In this large, heterogeneous population of patients with presumed osteoporosis, BTM testing was associated with treatment decision-making, likely leading to fragility fracture reduction following use.

Assessing the residential care needs of nursing home applicants.

In a study of nursing home applicants, residential care decisions made by a multidisciplinary assessment team were examined. The team agreed that of the 296 applicants assessed, 54 per cent required the high level of physical and supportive care provided in a nursing home. Hostel care was recommended for 17 per cent, continuing care at home for 17 per cent, hospice care for 1 subject, and in 13 per cent of cases the team postponed their decision. A decision for nursing home care was associated with low Barthel Index of Activities of Daily Living scores, dementia, incontinence and the absence of a carer willing to continue care. A decision to delay was associated, in most cases, with a requirement for further in-patient assessment and/or rehabilitation, and therefore with a potential for functional improvement. A decision for hostel care instead of home care was associated with a low level of informal support and the absence of a carer who was a spouse or daughter. The findings suggest that a program of geriatric assessment will accurately identify the differing care needs of nursing home applicants. The initial value of such an assessment program may be to contribute to the planning of residential and other long-term care services rather than to reduce inappropriate nursing home admissions.

Nursing home admissions: the effect of a multidisciplinary assessment team on the frequency of admission approvals.

In a study of nursing home applicants in the Lower North Shore Area of Sydney, the assessed requirement for nursing home care is compared with the Department of Community Services and Health's NH5 approval rate. A multidisciplinary team decided that only 62.6 per cent of 246 nursing home applicants required nursing home admission whereas 98.4 per cent had their applications approved by the Department. The findings suggest that by providing multidisciplinary assessment for nursing home applicants, the previously high approval rates for nursing home admission can be lowered and thus may reduce the number of inappropriate admissions that occur. However, the extent to which this reduction can be maintained will depend on how effective the alternative care options are in preventing or delaying nursing home admission.