• Recognize the high risk of first and recurrent fractures in persons living in nursing homes or long-term care facilities.
• Recognize the importance of vitamin D in bone health and appropriate replacement and maintenance doses of vitamin D.
• Identify appropriate treatment options for long-term care patients and nursing home residents based upon the new World Health Organization fracture risk tool, FRAX.

Angela R. Curtis, PhD
Managing Editor
Assistant Professor, Geriatric Education Manager
Division of Gerontology, Geriatrics and Palliative Care

Amy Warriner, MD
Assistant Professor, Division of Endocrinology and Metabolism

Jeffrey R. Curtis, MD, MPH
Assistant Professor, Division of Clinical Immunology and Rheumatology

University of Alabama at Birmingham
Birmingham, Alabama

Dr. Amy Warriner has no commercial affiliations to disclose.

Dr. Jeffrey Curtis would like to disclose that he has received grants/research support from Novartis, Merck, Proctor & Gamble, Eli Lilly and Amgen. He is a consultant with Roche, UCB, and Proctor & Gamble and he has received honoraria from Novartis, Merck, Proctor & Gamble, Eli Lilly and Roche.

Because of the nature of preliminary studies, some products mentioned are unlabeled and investigational. Dosages, indications, and methods of use of drugs mentioned in this publication may reflect the experience of the authors, clinical literature, or other resources. Therefore, please see the full prescribing information before using any licensed product mentioned.

The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Alabama School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The boards of nursing in many states, including Alabama, recognize Category 1 continuing medical education courses as acceptable activities for the renewal of license to practice nursing.

In 2005, it was estimated that more than 2 million fractures occurred as a result of osteoporosis [1]. One third of persons over the age of 65 fall each year [2] and 10% sustain either hip fracture or head injury following the fall [3]. Fractures often lead to limited mobility, decreased independence, and frequent institutionalization. Unfortunately, both patients and clinicians often fail to recognize that a fragility fracture confers the diagnosis of osteoporosis. As a result, most high risk patients do not receive osteoporosis treatments that have proven efficacy in reducing the risk of future fracture.

Up to 75% of persons require nursing home care following a hip fracture [4]. Despite the increased risk of recurrent fracture [5,6], osteoporosis is underdiagnosed and undertreated in long-term care patients [7-9]. Although fracture risk among average long-term care and home health patients is typically very high, a history of a prior fracture makes intervention even more compelling given the exceedingly high risk for a second fracture.

Mrs. O is an 81-year-old white woman who moved to the White Lakes Nursing Home one week ago. She was previously living at home and was very active in numerous community groups. However, two weeks ago she sustained a hip fracture after falling. She underwent surgical repair of her hip fracture. She is currently undergoing physical rehabilitation at the nursing home. Her other medical conditions include hypertension and hyperlipidemia. Her current medications are amlodipine and simvistatin.