Undertreatment of Osteoporosis in the Oldest Old? A Nationwide Study of over 700,000 Older People

Overview

Journal Arch Osteoporos

Publisher Springer

Date 2010 Mar 18

PMID 20234854

Citations 21

Authors

Kristina Johnell

Johan Fastbom

Affiliations

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Abstract

SUMMARY: We analysed data from elderly people registered in the Swedish Prescribed Drug Register to investigate whether age is associated with use of osteoporosis drugs in a nationwide population. Our results indicate an undertreatment of osteoporosis, particularly with bisphosphonates, in the oldest old in Sweden. INTRODUCTION: The aim of this study was to investigate whether age is associated with use of osteoporosis drugs in a large population of older people. METHODS: We analysed data on age, sex, type of residential area (urban/rural) and dispensed drugs for people aged >/=75 years registered in the Swedish Prescribed Drug Register from October to December 2005 (n = 731,105). Multivariate logistic regression was used to analyse whether age was associated with use of osteoporosis drugs, after adjustment for type of residential area and number of other drugs (a proxy for comorbidity). RESULTS: Osteoporosis drugs were used by 16.1% of the women and 3.4% of the men. The probability of use of bisphosphonates declined with increasing age [ORwomen = 0.36 (95% CI 0.34-0.38) and ORmen = 0.46 (95% CI 0.37-0.56) for age >/=90 years vs. 75-79 years]. Raloxifene was also negatively associated with age. Calcium + vitamin D supplements, however, showed a divergent pattern regarding age. In women, the lowest likelihood of use of calcium + vitamin D supplements occurred in the oldest old (>/=90 years). CONCLUSIONS: Our results indicate an undertreatment of osteoporosis, particularly with bisphosphonates, in the oldest old in Sweden. Future research is needed for understanding the mechanisms behind this age effect.

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References

Feldstein A, Elmer P, Orwoll E, Herson M, Hillier T . Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation. Arch Intern Med. 2003; 163(18):2165-72. DOI: 10.1001/archinte.163.18.2165. View

Freedman K, Kaplan F, Bilker W, Strom B, Lowe R . Treatment of osteoporosis: are physicians missing an opportunity?. J Bone Joint Surg Am. 2000; 82(8):1063-70. DOI: 10.2106/00004623-200008000-00001. View

Gajic-Veljanoski O, Sebaldt R, Davis A, Tritchler D, Tomlinson G, Petrie A . Age and drug therapy are key prognostic factors for first clinical fracture in patients with primary osteoporosis. Osteoporos Int. 2007; 18(8):1091-100. DOI: 10.1007/s00198-007-0340-1. View

Vik S, Jantzi M, Poss J, Hirdes J, Hanley D, Hogan D . Factors associated with pharmacologic treatment of osteoporosis in an older home care population. J Gerontol A Biol Sci Med Sci. 2007; 62(8):872-8. DOI: 10.1093/gerona/62.8.872. View

Borgstrom F, Zethraeus N, Johnell O, Lidgren L, Ponzer S, Svensson O . Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int. 2005; 17(5):637-50. DOI: 10.1007/s00198-005-0015-8. View

Zethraeus N, Borgstrom F, Strom O, Kanis J, Jonsson B . Cost-effectiveness of the treatment and prevention of osteoporosis--a review of the literature and a reference model. Osteoporos Int. 2006; 18(1):9-23. DOI: 10.1007/s00198-006-0257-0. View

Kanis J, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A . Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone. 2000; 27(5):585-90. DOI: 10.1016/s8756-3282(00)00381-1. View

Johnell O, Kanis J, Jonsson B, Oden A, Johansson H, De Laet C . The burden of hospitalised fractures in Sweden. Osteoporos Int. 2004; 16(2):222-8. DOI: 10.1007/s00198-004-1686-2. View

Wettermark B, Hammar N, Fored C, MichaelFored C, Leimanis A, Olausson P . The new Swedish Prescribed Drug Register--opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf. 2006; 16(7):726-35. DOI: 10.1002/pds.1294. View

10.

Avenell A, Gillespie W, Gillespie L, OConnell D . Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev. 2005; (3):CD000227. DOI: 10.1002/14651858.CD000227.pub2. View

11.

Chevalley T, Herrmann F, Delmi M, Stern R, Hoffmeyer P, Rapin C . Evaluation of the age-adjusted incidence of hip fractures between urban and rural areas: the difference is not related to the prevalence of institutions for the elderly. Osteoporos Int. 2002; 13(2):113-8. DOI: 10.1007/s001980200002. View

12.

Johnell O, Kanis J . An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006; 17(12):1726-33. DOI: 10.1007/s00198-006-0172-4. View

13.

Larsson S, Eliasson P, HANSSON L . Hip fractures in northern Sweden 1973-1984. A comparison of rural and urban populations. Acta Orthop Scand. 1989; 60(5):567-71. DOI: 10.3109/17453678909150124. View

14.

Kanis J, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby A . International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res. 2002; 17(7):1237-44. DOI: 10.1359/jbmr.2002.17.7.1237. View

15.

Kanis J, Burlet N, Cooper C, Delmas P, Reginster J, Borgstrom F . European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2008; 19(4):399-428. PMC: 2613968. DOI: 10.1007/s00198-008-0560-z. View

16.

Kiebzak G, Beinart G, Perser K, Ambrose C, Siff S, Heggeness M . Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med. 2002; 162(19):2217-22. DOI: 10.1001/archinte.162.19.2217. View

17.

Lekkerkerker F, Kanis J, Alsayed N, Bouvenot G, Burlet N, Cahall D . Adherence to treatment of osteoporosis: a need for study. Osteoporos Int. 2007; 18(10):1311-7. DOI: 10.1007/s00198-007-0410-4. View

18.

Johnell O, Kanis J, Oden A, Sernbo I, Redlund-Johnell I, Petterson C . Mortality after osteoporotic fractures. Osteoporos Int. 2003; 15(1):38-42. DOI: 10.1007/s00198-003-1490-4. View

19.

Strom O, Borgstrom F, Sen S, Boonen S, Haentjens P, Johnell O . Cost-effectiveness of alendronate in the treatment of postmenopausal women in 9 European countries--an economic evaluation based on the fracture intervention trial. Osteoporos Int. 2007; 18(8):1047-61. DOI: 10.1007/s00198-007-0349-5. View

20.

McClung M, Geusens P, Miller P, Zippel H, Bensen W, Roux C . Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med. 2001; 344(5):333-40. DOI: 10.1056/NEJM200102013440503. View