What bone health protection best practices are effective in long-term care?

1. What bone health protection best practices are effective in long-term care? 1

2. Bone Health Protection StrategiesBest Practices Vitamin D 800-2000 IU supplements daily 1 • Extremely low cost per year for Vitamin D • Benefits in LTC with 800 IU Vitamin D +1200 mg Calcium 43% reduction in hip fractures1 • Vitamin D 700-1000 IU reduces hip fractures by 26%, all non-vertebral fractures by 23% and falls by 20%2-6 Papaioannou, A et al., 2010 Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada, CMAJ, 2010. Hanley DA, Cranney A, Jones G, Whiting SJ, Leslie WD, Cole DE, et al. Vitamin D in adult health and disease: A review and guideline statement from osteoporosis canada. CMAJ. 2010 Jul 26. ChapuyMC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N.Engl.J.Med. 1992 Dec 3;327(23):16371642. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 2009 Oct 1;339:b3692. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, et al. Effect of Vitamin D on falls: a meta-analysis. JAMA 2004 Apr 28;291(16):1999-2006. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 2005 May 11;293(18):2257-226B4. Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, et al.Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis Bischoff-Ferrari H. Vitamin D: what is an adequate vitamin D level and how much supplementation is necessary? Best Pract.Res.Clin.Rheumatol. 2009 Dec;23(6):789-795. 2

3. Bone Health Protection StrategiesBest Practices Vitamin D 8000-2000 IU supplements daily • Vitamin D • Improves bone density, muscle function, body sway and coordination. • Reduces muscle pain, hip and spinal fractures and the debilitating effects of osteoporosis1-5 • Essential for the prevention of osteoporosis • 15 residents would need to be treated to prevent 1 from falling Papaioannou, A et al., 2010 Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada, CMAJ, 2010. Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, et al.Interventions for preventing falls in older people in nursing care facilities and hospitals.Cochrane Database Syst.Rev. 2010 Jan 20;(1)(1):CD005465. Dawson-Hughes B. Serum 25-hydroxyvitamin D and functional outcomes in the elderly. Am.J.Clin.Nutr. 2008 Aug;88(2):537S-540S. Pfeifer M, Begerow B, Minne HW, Suppan K, Fahrleitner-Pammer A, Dobnig H. Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos.Int. 2009 Feb;20(2):315-322. Hanley D et al. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada CMAJ 2010. DOI:10.1503/cmaj.091062 3

4. Less than 10% of residents are treated1,2 • Vitamin D, Calcium and Bisphosphonates • Average length of stay is 2.5 years in LTC • Duque et al., J Am Med Dir Assoc 2006; 7: 435–441 • Giangregorio LM et al.. Osteo Int 2009; 20(9):1471-8 4