We aim to describe people who live in care homes (nursing or residential care homes) in the United Kingdom (UK). We will describe characteristics about care home residents that might be related to a condition of having weak bones (osteoporosis), including: age, sex, ethnicity, deprivation, and health-related characteristics, such as having other diseases, use of various medications, history of falls, and history of fractures after a minimal trauma (eg, a fall from a standing height). We will also determine how often people experience fracture, what percentage receive treatment after the fracture, what percentage is admitted to a hospital, how long do they stay in the hospital, what percentage die within a year after the fracture, number of people diagnosed with osteoporosis, and what medications are prescribed to treat osteoporosis. We will also describe these characteristics in the general population (ie, individuals of the same age, but who do not live in care homes) to help us understand if osteoporosis-related characteristics, the frequency of osteoporosis, frequency of fractures, and treatment for osteoporosis differ among people living in care homes and the general population. Knowing the specific characteristics of the care home residents will help the design of targeted healthcare services.
We aim to describe the characteristics of people who live in care homes in the UK using primary-care electronic health record (EHR) data from CPRD and linked Hospital Episode Statistics (HES) in terms of osteoporosis-related characteristics, outcomes, and patterns of care.
Specific objectives: 1) to describe demographic and clinical characteristics, in terms of risk factors for fracture; 2) to describe patterns of osteoporosis care; 3) to estimate the annual fracture incidence rate in 2012-2019; 4) to describe post-fracture management and outcomes; 5) to investigate persistence to osteoporosis treatment among new users of antiresorptive therapies. Exploratory aim - to assess recording and coding of Dual energy x-ray absorptiometry (DXA).
Outcomes:
a) in the whole care home population: 1) demographic and clinical characteristics; 2) number of people with osteoporosis diagnosis and prescribed osteoporosis treatment, types of osteoporosis treatment; 3) fracture incidence rate; 4) number of individuals with falls and proportion of them resulting in fractures; and 5) DXA. Outcomes (1) and (3) will also be measured in a matched cohort from the general population (matched on age, sex, calendar period and GP practice).
b) among those with a fracture (first fracture after the index): 1) proportion of individuals who received antiresorptive therapy (and by type) within 12 months after the fracture; 2) proportion of fractures resulting in osteoporosis diagnosis; 3) hospitalisation; 4) transfer to intermediate care; and 5) 1-year post-fracture mortality.
c) in the population with osteoporosis treatment initiation after index: cumulative incidence of non-persistence to treatment.
This is a descriptive study: summary statistics will be used for the data analysis (eg, means, medians, proportions). We will also present descriptive statistics for a matched general population cohort to put the results from the care home population into context.
HES and ONS data will be used to determine hospitalizations and date of death.
Osteoporosis diagnosis; Osteoporosis treatment; Type of osteoporosis treatment (including bisphosphates, denosumab, raloxifene, teriparatide, strontium ranelate) The updated list of osteoporosis treatments includes currently relevant and most common treatments: bisphosphates, denosumab, raloxifene, teriparatide, and strontium ranelate.; Fracture incidence rate; Treatment with antiresorptive therapy within 12 months after the fracture; Hospitalisation; Transfer to intermediate care; Mortality after fracture; Persistence to osteoporosis treatment
James O'Kelly - Chief Investigator - Amgen Ltd
James O'Kelly - Corresponding Applicant - Amgen Ltd
Kathryn Mansfield - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Matthew McDermott - Collaborator - Amgen Ltd
Natalie Eugene - Collaborator - Amgen Ltd
Rohini Mathur - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Vaiva Gerasimaviciute - Collaborator - Amgen Ltd
Joe Maskell - Collaborator - Amgen Ltd
2011 Rural-Urban Classification at LSOA level;HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation