Osteoporosis-related characteristics in care home residents in England: a retrospective cohort study.

BACKGROUND: The characteristics of care home populations, with respect to fracture risk factors, have not been well-defined. AIM: To describe osteoporosis-related characteristics among care home residents, including fracture risk factors, fracture rates, post-fracture outcomes, and osteoporosis treatment duration. DESIGN & SETTING: A descriptive cohort study of care home residents aged ≥60 years (n = 8366) and a matched cohort of non-care home residents (n = 16 143) in England from 2012 to 2019. Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES) and Office for National Statistics (ONS) death data were used. METHOD: The characteristics were assessed using descriptive statistics. Fracture risk factors and fracture rates were described in both the care home and matched population. In the care home population, Kaplan-Meier curves were plotted to assess osteoporosis treatment duration. RESULTS: At index, fracture risk factors were more common in care home residents versus the matched cohort, including body mass index (BMI) <18.5 (12.2% versus 5.1%), history of falls (48.9% versus 30.7%), prior fracture (26.5% versus 10.8%), and prior hip fracture (17.1% versus 5.8%). Fracture rate was 43.5 (95% confidence interval [CI] = 39.7 to 47.5) in care home residents and 28.0 (95% CI = 26.3 to 29.9) per 1000 person-years in the matched cohort. Overall, osteoporosis treatment was initiated in 3.6% (n = 225/6265) of care home residents and 45.9% remained on treatment at 12 months. Among care home residents who experienced fracture, 21.9% (n = 72/329) received an osteoporosis diagnosis; 21.2% (n = 63/297) initiated osteoporosis treatment post-hip fracture. CONCLUSION: Care home residents had more fracture risk factors and higher fracture rates than the matched cohort; however, osteoporosis diagnosis, treatment rates, and treatment duration were low. There is an opportunity to improve osteoporosis management in this vulnerable population.

Reciprocal associations between depression, anxiety and work-related injury.

OBJECTIVE: To examine the reciprocal longitudinal associations between depression or anxiety with work-related injury (WRI) at a large employer in the southwestern United States. METHOD: Three administrative datasets (2011-2013) were merged: employee eligibility, medical and prescription claims, and workers' compensation claims. The sample contained 69 066 active employees. Depression and anxiety were defined as episodes of medical visits care (ie, claims) with corresponding ICD-9-CM codes. For an individual's consecutive claims, a new case of depression or anxiety was defined if more than 8 weeks have passed since the prior episode. The presence of a workers' compensation injury claim was used to identify WRI. Three-wave (health plan years 2011 or T1, 2012 or T2, and 2013 or T3) autoregressive cross-lagged models were used to estimate whether depression or anxiety predicted WRI, also if WRI predicted depression or anxiety in the following year(s). RESULTS: Depression predicted injury from T1 to T2 (ß=0.127, p<0.001) and from T2 to T3 (ß=0.092, p=0.001). Injury predicted depression from T1 to T3 (ß=0.418, p<0.001). Effects of anxiety on WRI were small and inconsistent, from T1 to T2 (ß=0.013, p=0.622) and from T2 to T3 (ß=-0.043, p=0.031). T1 injury had a protective effect on T3 anxiety (ß=-0.273, p<0.001). CONCLUSIONS: We found evidence of reciprocal effects for depression with WRI after adjustment for prior injuries and depression. The evidence for the relationship between anxiety and WRI is less clear. WRI prevention and management programmes should incorporate depression prevention and management.