Introduction and Hypothesis: We determined the prevalence and predictors of osteoporosis evaluation and treatment in high risk nursing home residents. Methods: We identified 67 nursing facilities in North Carolina and Arizona with >= 10 residents with osteoporosis or recent hip fracture. Medical records (n=895) were abstracted for osteoporosis evaluation (DXA, vitamin D level, serum calcium), treatment (calcium, vitamin D, osteoporosis medication, hip protectors), clinical and systems covariates. Data were analyzed at the facility level and using mixed models to account for the complex nesting of residents within providers and nursing facilities. Results: Calcium and vitamin D was prescribed for 69% of residents, bisphosphonates for 19%, calcitonin for 14%, other pharmacologic therapies for 6%, and hip protectors for 2%. Overall, 36% received any bone protection (medication or hip protectors) with wide variation among facilities (0 to 85%). Factors significantly associated with any bone protection include female sex [OR 2.4, (1.5–3.7)] and non-urban/suburban location [1.5, (1.1–2.2)]. Residents with esophagitis, PUD, or dysphagia [0.6, ( 0.4–0.9)] and alcohol abuse [0.2, (0.0–0.9)] were less likely to receive treatment. Conclusions: There is substantial variation in the quality of osteoporosis treatment across nursing homes. Interventions which improve osteoporosis quality of care are needed
