The most widely used osteoporosis medication in residential aged care – denosumab and bisphosphonates – are frequently missed or delayed, which can lead to vertebral fractures in as short as 30 days, according to research from the Australian Institute of Health Innovation at Macquarie University.
The retrospective cohort study analysed electronic medication administration data of 10,674 residents who were treated for osteoporosis with denosumab or bisphosphonates in 413 aged care homes from 2018 to 2022. Denosumab is used by 87 per cent of residents, and the injection must be administered strictly every six months.
However, the research – published in the British Journal of Clinical Pharmacology – found one in five did not get their dose on time. Further, almost all who stopped denosumab treatment did not receive the follow-on bisphosphonate therapy, which is recommended for 12 to 24 months as protection against bone loss.
The findings challenge the idea that once medicine is prescribed in an aged care home it will be administered correctly and safely, said senior author Associate Professor Magda Raban.
Associate Professor Magda Raban (AIHI)
“Denosumab works very well when given correctly. But our research shows that in aged care settings, 20 per cent of people prescribed denosumab experienced delayed or missed doses, and when treatment is stopped, residents are almost never given the recommended replacement therapy. This creates a serious and avoidable risk of fractures in a very vulnerable population,” Dr Raban said.
Correct osteoporosis management in aged care is a critical patient safety issue as fractures in older people are associated with pain, loss of mobility, hospitalisation and increased mortality.
The problem lies with how the health system supports medication use, not the medication itself, said lead author Marea O’Donnell.
“Denosumab treatment requires a six-monthly injection, and the logistics of timely ordering and supply can be complex in residential aged care,” Ms O’Donnell said.
Knowledge can empower family members
The findings also highlight the importance of residents and families in medication management, Ms O’Donnell said.
Marea O’Donnell (AIHI)
“Understanding that missed or delayed injections carry real risks empowers residents and families to ask the right questions about medication schedules, transitions to and from hospital and what happens if treatment is interrupted,” Ms O’Donnell said.
Associate Professor Raban said that better coordination across aged care homes and hospitals, and a greater role for aged care pharmacists, could help ensure injections are given on time and that safe replacement therapy is initiated if treatment stops.
Digital systems can help
The authors also noted that improved use of electronic medication systems could help prevent errors and ensure the timely supply and availability of injections.
“Our future research aims to design and evaluate digital solutions to ensure timely and safe management of denosumab,” Dr Raban told Australian Ageing Agenda.
“We will leverage the great potential for digital medication systems to support timely and guideline concordant medication supply, administration and prescribing in residential aged care,” she said.
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