# Deprescribing Bisphosphonates in Older Nursing Home Residents with Dementia

> **NIH NIH K08** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2022 · $145,320

## Abstract

PROJECT SUMMARY/ABSTRACT.
Polypharmacy is a highly prevalent problem in older adults, particularly in those with Alzheimer’s Disease (AD)
and AD-Related Dementias (AD/ADRD) and those residing in the nursing home (NH). Many older adults
continue to receive medications originally prescribed for disease prevention until the end of life, despite a lack
of sufficient evidence to justify their continued use in advanced age. The use of bisphosphonates for fracture
prevention is one example. Although bisphosphonates are effective in reducing fractures in healthier,
community-dwelling individuals, there is insufficient evidence of continued benefits that is generalizable for NH
residents with AD/ADRD. There is also substantial clinical heterogeneity in this population with regards to
fracture risk, mobility, and life expectancy, creating further uncertainty as to whether all NH residents with
AD/ADRD benefit from bisphosphonate use. Deprescribing is a patient-centered approach to reduce or stop
medications that are no longer appropriate considering goals of care, time until benefit, and life expectancy.
Considering the lack of strong generalizable evidence and potential for side effects, bisphosphonates may be
targeted for deprescribing in NH residents with AD/ADRD. Deprescribing may also be justifiable considering
the extended period of benefit of bisphosphonates, which may last for up to 2 years after discontinuation
exceeding the life expectancy of many residents with AD/ADRD. However, no studies to date have evaluated
the appropriateness of deprescribing bisphosphonates as a means to reduce the burden of polypharmacy and
adverse effects in this population. Large observational studies of secondary data are uniquely positioned to
evaluate the benefits and harms of medication use and deprescribing in older NH residents with AD/ADRD,
given the barriers to conducting randomized studies in this population. This study will evaluate determinants,
clinical outcomes, and cost-effectiveness of deprescribing bisphosphonates in NH residents with AD/ADRD. In
Aim 1, we will conduct a qualitative study using semi-structured interviews to identify determinants of
deprescribing bisphosphonates from the perspectives of family/informal caregivers and prescribers of
NH residents with AD/ADRD. In Aim 2, we will conduct an observational study of Medicare
administrative data to evaluate clinical outcomes (fractures and adverse effects) associated with
deprescribing bisphosphonates in a sample of older NH residents with AD/ADRD. In Aim 3, we will
evaluate the cost-effectiveness of deprescribing bisphosphonates in NH residents with AD/ADRD,
considering medication costs and utilization for fractures and adverse effects. This study will address a
critical gap in knowledge and inform future recommendations for optimizing bisphosphonate use to prevent
fractures in this vulnerable and medically complex population. This award will also provide the principal
investigator with protect...

## Key facts

- **NIH application ID:** 10380865
- **Project number:** 5K08AG071794-02
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Joshua David Niznik
- **Activity code:** K08 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $145,320
- **Award type:** 5
- **Project period:** 2021-04-01 → 2026-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10380865

## Citation

> US National Institutes of Health, RePORTER application 10380865, Deprescribing Bisphosphonates in Older Nursing Home Residents with Dementia (5K08AG071794-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10380865. Licensed CC0.

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