Osteoporosis Risk in Frail Older Adults in Assisted Living

To compare osteoporosis risk in residents of assisted living (AL) with that of age- and sex-matched community-dwelling adults. Cross-sectional. Community and AL facilities in Connecticut. One hundred seven individuals (77 control, 37 AL). Fracture and osteoporosis evaluation history, qualitative heel ultrasound (QUS), 25-hydroxyvitamin D (25OHD), parathyroid hormone (PTH), and physical function measures, including walking speed, chair rise time, 6-minute walk, Berg Balance Scale, Get Up and Go, and handgrip strength. Participants' mean age was 82.7 +/- 5.7. There were no group differences in reported fracture, diagnosis of osteoporosis, or previous bone mineral density (BMD) assessment. QUS T-scores were -1.0 +/- 1.5 for community living and -1.9 +/- 1.3 for AL (P=.002), 25OHD levels were 113.0 +/- 40.1 nnmol/L for community living and 81.8 +/- 36.9 for AL (P <.001), and PTH levels were 50.8 +/- 29.8 pg/mL for community living and 58.8 +/- 32.8 pg/mL for AL (P=.22). Physical performance was more impaired in AL (P <.05), except for single leg stance (P=.16). In linear regression analysis, age, sex, and site of residence were significant predictors of heel T-score, explaining 53.7% of the variance. Residents of AL did not report less fracture or osteoporosis than those from the community, but risk factors measured directly were significantly different, including lower BMD and 25OHD and more impairment in measures of physical function. These data suggest that residents of AL are at greater risk for osteoporotic fracture and that measures to diminish risk (optimizing vitamin D status, implementing fall prevention strategies, incorporating exercise to improve physical performance) should be considered and studied for benefit.