One in five aged care residents receive delayed or missed denosumab doses

Medication administration data from more than 10,600 residential aged care residents has led researchers to claim older Australians are being put at risk of fractures.

The study from Macquarie University’s Australian Institute of Health Innovation (AIHI) revealed that doses of denosumab — used by 86.9% of older adults on osteoporosis treatment in residential aged care (RAC) — are being frequently missed or delayed, leading, the researchers say, to rapid weakening of bones in the spine and increased fracture risk for older Australians.

Published open access (doi: 10.1002/bcp.70574) in the British Journal of Clinical Pharmacology in April, medication administration data from 2018 to 2022 was analysed, which included more than 10,600 RAC residents across Australia and found that one in five people prescribed denosumab experienced doses that were delayed beyond recommended timeframes.

Strictly required every six months, missing or delaying a denosumab dose or stopping without appropriate replacement therapy can lead to vertebral fractures due to rapid bone resorption, even with delays as short as 30 days, the researchers said. The analysis also revealed that almost all residents who stopped denosumab treatment (more than 98%) were not given follow-on bisphosphonate therapy, which clinical guidelines recommend should be given for 12 to 24 months as protection against bone loss.

“Denosumab works very well when given correctly,” said senior author Associate Professor Magda Raban. “But our research shows that in aged care settings, 20% 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.”

Pharmacist and AIHI researcher Marea O’Donnell is lead author of the study and said the problem is not with the medication but with the health system that supports its use — pointing to improved use of electronic medication systems as having the potential to prevent errors and ensure the timely supply and availability of injections. Raban said helping ensure injections are given on time and that safe replacement therapy is initiated if treatment stops could potentially be achieved through better coordination across RAC and hospitals, and a stronger role for aged care pharmacists.

“Denosumab treatment requires a six-monthly injection, and the logistics of timely ordering and supply can be complex in residential aged care,” O’Donnell said. “Understanding that missed or delayed injections carries 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.”

Image credit: iStock.com/Jacob Wackerhausen